From the Guidelines
A left middle cerebral artery (MCA) stroke requires immediate treatment, including administration of tissue plasminogen activator (tPA) if within 4.5 hours of symptom onset, and consideration of decompressive craniectomy in patients under 60 years old with deteriorating neurological status despite medical therapy, as recommended by the American Heart Association/American Stroke Association 1. The management of a left MCA stroke involves several key components, including:
- Immediate administration of tPA if within the therapeutic window, at a dose of 0.9 mg/kg with 10% given as bolus and the remainder over 60 minutes 1
- Consideration of mechanical thrombectomy for eligible patients outside the tPA window, up to 24 hours after symptoms begin
- Secondary prevention with antiplatelet therapy, such as aspirin (81-325 mg daily) or clopidogrel (75 mg daily), and statins like atorvastatin (40-80 mg daily) regardless of baseline cholesterol levels
- Blood pressure management targeting <140/90 mmHg using medications like ACE inhibitors or ARBs
- Rehabilitation, including physical, occupational, and speech therapy, as soon as possible
- Lifestyle modifications, such as smoking cessation, limited alcohol intake, regular exercise, and a Mediterranean or DASH diet, to promote recovery and prevent recurrent strokes In patients with significant brain swelling, management strategies may include:
- Restriction of free water to avoid hypo-osmolar fluid
- Correction of factors that could exacerbate swelling, such as hypoxemia, hypercarbia, and hyperthermia
- Elevation of the head of the bed to 20° to 30° to facilitate venous drainage
- Avoidance of antihypertensive agents that may cause cerebral vasodilatation
- Consideration of decompressive craniectomy in patients under 60 years old with deteriorating neurological status despite medical therapy, as recommended by the American Heart Association/American Stroke Association 1.
From the Research
LEFT MCA STROKE
- A left MCA stroke refers to a type of ischemic stroke that occurs when the middle cerebral artery (MCA) on the left side of the brain is blocked, resulting in damage to the surrounding brain tissue 2, 3, 4.
- The MCA is one of the largest arteries in the brain and supplies blood to a significant portion of the lateral surface of the brain, including areas responsible for language, motor function, and sensory processing 4, 5.
- A left MCA stroke can result in a range of symptoms, including weakness or paralysis of the right face and arm, difficulty with speech and language, and sensory deficits such as numbness or tingling in the right arm and leg 3, 6.
Risk Factors
- Atrial fibrillation is a significant risk factor for left MCA stroke, as it can lead to the formation of blood clots that can travel to the brain and block the MCA 2, 3, 4, 6.
- Other risk factors for left MCA stroke include hypertension, hyperlipidemia, diabetes, and heart failure 2, 3, 6.
- The presence of atherosclerotic disease in the MCA or other cerebral arteries can also increase the risk of stroke 5.
Diagnosis and Treatment
- Diagnosis of a left MCA stroke typically involves imaging studies such as computed tomography (CT) or magnetic resonance imaging (MRI) to visualize the brain and identify areas of damage 4, 5.
- Treatment for a left MCA stroke may include medications to dissolve blood clots, surgical procedures to remove blockages or repair damaged blood vessels, and rehabilitation therapies to help restore language, motor, and cognitive function 3, 6, 5.
- The use of anticoagulants, such as non-vitamin K antagonist oral anticoagulants (NOACs), can help prevent recurrent strokes in patients with atrial fibrillation 6.