Brain Middle Artery Stroke Symptoms and Clinical Manifestations

The middle cerebral artery (MCA) is one of the major arteries supplying blood within the skull. Each MCA provides circulation to nearly three-fifths of the same-side cerebral hemisphere. When a blockage occurs in the MCA, it can lead to severe neurological symptoms. A major occlusion often results in the classic triad of hemiplegia, hemisensory loss, and homonymous hemianopia on the opposite side of the body.

Common Symptoms of MCA Occlusion

Contralateral hemiplegia typically affects the lower half of the face, including eyelid muscles, facial expressions, tongue movement, and limbs. If the dominant hemisphere is involved, patients may develop global aphasia, which means they are unable to produce or comprehend spoken language. In contrast, when the non-dominant hemisphere is affected, patients may experience somatoparaphrenia or other body image disorders, where they lose the ability to accurately perceive their own body parts or spatial orientation.

Effects of Different Types of MCA Infarction

In cases of large vessel occlusion leading to extensive cerebral infarction, severe brain edema may develop, potentially causing brain herniation and life-threatening complications. When smaller branches are affected, such as the deep penetrating arteries, patients may experience mild, equal hemiparesis and sensory deficits, sometimes accompanied by homonymous visual field loss.

Superficial vs. Deep Branch Involvement

Superficial cortical branch occlusions can lead to facial paralysis and impaired movement and sensation in the upper extremities, while the lower limbs are usually less affected. In contrast, occlusion of the lower cortical branches is relatively rare and does not typically cause hemiplegia.

Understanding the varied clinical presentations of MCA infarction helps clinicians accurately localize the lesion, improve diagnostic accuracy, and guide effective treatment strategies. Early recognition of symptoms is crucial for timely intervention and better patient outcomes.