From the Research
Introduction to Middle Cerebral Artery Syndrome
The Middle Cerebral Artery (MCA) syndrome is a condition that occurs when there is a blockage or obstruction in the middle cerebral artery, which is one of the main arteries that supply blood to the brain [ 1 ]. This syndrome can result in a range of symptoms, including contralateral hemiplegia, sensory loss, and language deficits, depending on the area of the brain that is affected [ 1 ].
Clinical Presentation
The clinical presentation of MCA syndrome can vary depending on the location and extent of the blockage [ 2 ]. Common symptoms include changes in personality, judgment, or motor synchronization disturbances, disorientation, hemianopia, or hemineglect [ 2 ]. In some cases, there may be an overlapping of artery infarcts, resulting in insular syndrome and sensitive, motor, or language disturbances [ 2 ].
Anatomical Variations
The MCA has several anatomical variations that can affect its function and increase the risk of blockage [ 3 ]. These variations include accessory MCA, duplicated MCA, fenestration of MCA, and duplicated origin of MCA [ 3 ]. Additionally, there can be unfused or twig-like MCA, which indicates MCA trunk occlusion with collateral plexiform arterial network [ 3 ].
Diagnosis and Treatment
Diagnosis of MCA syndrome typically involves imaging studies such as computed tomography (CT) or magnetic resonance imaging (MRI) [ 1 ]. Treatment options may include mechanical thrombectomy, which involves the use of a device to remove the blockage from the artery [ 1 ]. In some cases, decompressive craniectomy may be necessary to relieve pressure on the brain [ 4 ].
Management and Prognosis
Management of MCA syndrome requires a multidisciplinary approach, including medical and surgical options [ 4 ]. The prognosis for patients with MCA syndrome can vary depending on the severity of the blockage and the promptness of treatment [ 4 ]. In general, early recognition and treatment of MCA syndrome can improve outcomes and reduce the risk of long-term disability [ 1 ].
Treatment Options
- Mechanical thrombectomy: a procedure that involves the use of a device to remove the blockage from the artery [ 1 ]
- Decompressive craniectomy: a surgical procedure that involves removing a portion of the skull to relieve pressure on the brain [ 4 ]
- Medical management: may include the use of medications to control blood pressure, prevent further blockage, and manage symptoms [ 4 ]
Dosing Information
- Tissue plasminogen activator (tPA): may be administered intravenously at a dose of 0.9 mg/kg, with a maximum dose of 90 mg [ 1 ]
Differential Diagnosis
- Unilateral moyamoya disease: a condition that can cause stenotic change in the MCA [ 3 ]
- Other causes of stroke or cerebral vasculopathy: such as cardioembolic stroke or vasculitis [ 2 ]