From the Research
Introduction to Middle Cerebral Artery Syndrome
The Middle Cerebral Artery (MCA) syndrome is a condition that occurs when the MCA, one of the main arteries that supply blood to the brain, is affected by a blockage or anomaly [ 1 ]. This can lead to a range of symptoms, including contralateral hemiplegia, sensory loss, and language deficits, depending on the area of the brain that is affected [ 2 ].
Anatomy of the Middle Cerebral Artery
The MCA is a complex artery with a variable anatomy, which can make it challenging to diagnose and treat MCA syndrome [ 3 ]. The artery has several branches, including the orbitofrontal, prefrontal, precentral, central, temporopolar, anterior temporal, middle temporal, posterior temporal, temporo-occipital, anterior parietal, angular, and posterior parietal arteries [ 3 ]. The MCA also has perforators, which are small branches that supply blood to the basal ganglia and other deep structures of the brain [ 3 ].
Causes of Middle Cerebral Artery Syndrome
MCA syndrome can be caused by a range of factors, including embolic mechanisms, thrombosis, and anomalies of the MCA [ 4 ]. Embolic mechanisms are the most common cause of MCA syndrome, and can occur when a blood clot or other debris forms in the artery and blocks the flow of blood to the brain [ 4 ]. Thrombosis, or the formation of a blood clot in the artery, can also cause MCA syndrome [ 2 ]. Anomalies of the MCA, such as accessory or duplicated arteries, can also increase the risk of MCA syndrome [ 1 ].
Symptoms of Middle Cerebral Artery Syndrome
The symptoms of MCA syndrome can vary depending on the area of the brain that is affected [ 4 ]. Common symptoms include:
- Contralateral hemiplegia, or weakness or paralysis of the opposite side of the body
- Sensory loss, or numbness or tingling in the opposite side of the body
- Language deficits, such as aphasia or difficulty speaking
- Changes in personality or behavior
- Judgment or motor synchronization disturbances
- Disorientation
- Hemianopia, or blindness in one half of the visual field
- Hemineglect, or neglect of one half of the body
Diagnosis and Treatment of Middle Cerebral Artery Syndrome
Diagnosis of MCA syndrome typically involves imaging studies, such as computed tomography (CT) or magnetic resonance imaging (MRI) [ 2 ]. Treatment may involve mechanical thrombectomy, or the use of a device to remove the blood clot from the artery [ 2 ]. In some cases, intravenous tissue plasminogen activator (tPA) may be administered to dissolve the blood clot [ 2 ]. Surgical intervention may also be necessary in some cases [ 1 ].
Differential Diagnosis
The differential diagnosis for MCA syndrome includes other conditions that can cause similar symptoms, such as:
- Unilateral moyamoya disease
- Other types of stroke, such as anterior cerebral artery or posterior cerebral artery stroke
- Transient ischemic attack (TIA)
- Brain tumor or other mass lesion
Caveats and Considerations
It is essential to consider the variable anatomy of the MCA and the potential for anomalies when diagnosing and treating MCA syndrome [ 3 ]. A thorough understanding of the neuroangiography patterns and anomalies of the MCA is crucial for accurate diagnosis and effective treatment [ 5 ]. Additionally, a multidisciplinary approach, including neurologists, radiologists, and neurosurgeons, may be necessary to manage MCA syndrome effectively [ 2 ].