MIDDLE CEREBRAL ARTERY


The Middle Cerebral Artery (MCA) is the most common site of stroke.
MCA infarcts occur in 2 general regions:  Superficial Divisions & Lenticulostriate Branches

Structures supplied by the MCA:

  • Left Superficial Division
  • Right Superficial Division
  • Lenticulostriate Branches
  • Clinical Syndromes of MCA Territories


BROCA'S AREA

Expressive speech area.
Integration with other language areas.

WERNICKE'S AREA

Receptive speech area.
Integration with other language areas.

MOTOR CORTEX

Movement of right head and neck,
movement of right arm.

SENSORY CORTEX

Sensation from right head and neck,
sensation from right arm.

MOTOR CORTEX

Movement of left head and neck,
movement of left arm.

SENSORY CORTEX

Sensation from left head and neck,
sensation from left arm.

STRIATUM (Caudate and Putamen)

Receives cortical inputs to basal ganglia.
Functions in the direct and indirect pathways for the initiation and control of movement.

GLOBUS PALLIDUS

Site of origin of output from the basal ganglia to substantia nigra and thalamus. Functions in the direct and indirect pathways for the initiation and control of movement.

INTERNAL CAPSULE (Anterior Limb)

Contains corticopontine and thalamocortical fibers.

INTERNAL CAPSULE (Genu)

Contains descending fibers of the corticobulbar tract.

LOCATION OF INFARCT

Left MCA Superficial Division




Right MCA Superficial Division




Left MCA Lenticulostriate Branches



Right MCA Lenticulostriate Branches

DEFICITS

Right face and arm upper-motor weakness due to damage to motor cortex, nonfluent (Broca’s) aphasia due to damage to Broca’s area. There may also be right face and arm cortical type sensory loss if the infarct involves the sensory cortex. Other deficits include a fluent (Wernicke’s) aphasia due to damage to Wernicke’s area.

Left face and arm upper-motor weakness due to damage to motor cortex. Left hemineglect (variable) due to damage to non-dominant association areas. There may also be left face and arm cortical type sensory loss if the infarct involves the sensory cortex.

Right pure upper-motor hemiparesis due to damage to the basal ganglia (globus pallidus and striatum) and the genu of the internal capsule on the left side. Larger infarcts extending to the cortex may produce cortical deficits such as aphasia.

Left pure upper-motor hemiparesis due to damage to the basal ganglia (globus pallidus and striatum) and the genu of the internal capsule on the right side. Larger infarcts extending to the cortex may produce cortical deficits such as aphasia.