Clinical features of occlusion of the middle cerebral artery

1. Big picture

The middle cerebral artery (MCA) is the artery most often involved in large anterior-circulation ischemic stroke. Clinically, MCA occlusion is high-yield because it produces the classic contralateral face–arm dominant hemiparesis, often with aphasia if the dominant hemisphere is affected, or neglect/anosognosia if the non-dominant hemisphere is affected.

For the exam, the most important idea is:

MCA stroke = cortical stroke with face and arm more affected than leg + possible aphasia/neglect + visual field defect + gaze deviation.

The lecture material emphasizes that in supratentorial/carotid territory stroke, if the MCA is affected, paresis is usually more severe in the upper limb than the lower limb, and if the dominant hemisphere cortex is involved, aphasia may appear. Spatial disorientation suggests right hemispheric involvement.