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 us