Middle cerebral artery syndrome

Middle cerebral artery syndrome is a condition whereby the blood supply from the middle cerebral artery (MCA) is restricted, leading to a reduction of the function of the portions of the brain supplied by that vessel: the lateral aspects of frontal, temporal and parietal lobes, the corona radiata, globus pallidus, caudate and putamen. The MCA is the most common site for the occurrence of ischemic stroke.[1]

Middle cerebral artery syndrome
Outer surface of cerebral hemisphere, showing areas supplied by cerebral arteries. (Pink is region supplied by middle cerebral artery.)
SpecialtyNeurology 

Depending upon the location and severity of the occlusion, signs and symptoms may vary within the population affected with MCA syndrome. More distal blockages tend to produce milder deficits due to more extensive branching of the artery and less ischemic response. In contrast, the most proximal occlusions result in widespread effects that can lead to significant cerebral edema, increased intracranial pressure, loss of consciousness and could even be fatal.[1] In such occasions, mannitol (osmotic diuretic) or hypertonic saline are given to draw fluid out of the edematous cerebrum to minimise secondary injury. Hypertonic saline is better than mannitol, as mannitol being a diuretic will decrease the mean arterial pressure and since cerebral perfusion is mean arterial pressure minus intracranial pressure, mannitol will also cause a decrease in cerebral perfusion.

Contralateral hemiparesis and hemisensory loss of the face, upper and lower extremities is the most common presentation of MCA syndrome.[1] Lower extremity function is more spared than that of the faciobrachial region.[2] The majority of the primary motor and somatosensory cortices are supplied by the MCA and the cortical homunculus can, therefore, be used to localize the defects more precisely. Middle cerebral artery lesions mostly affect the dominant hemisphere i.e. the left cerebral hemisphere.

Signs and Symptoms

Note: *faciobrachial deficits greater than that of the lower limb[1][3]

Diagnosis

Diagnosis can be confirmed by CT Scan or MRI for advanced investigations.

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References
  1. O'Sullivan, Susan (2007). "Physical Rehabilitation", p.711-712. F.A. Davis, Philadelphia. ISBN 0-8036-1247-8
  2. The Internet Stroke Center. Stroke syndromes: Middle cerebral artery - superior division. [Internet]. [updated 1999 July; cited 2011 May 13]. Retrieved from http://www.strokecenter.org/prof/syndromes/syndromePage5.htm
  3. The Internet Stroke Center. Stroke syndromes: Middle cerebral artery - inferior division. [Internet]. [updated 1999 July; cited 2011 May 13]. Retrieved from http://www.strokecenter.org/prof/syndromes/syndromePage6.htm
Classification
External resources
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