10 Questions
In most patients, the MCA in the sylvian fissure divides into superior and inferior divisions.
True
Branches from the inferior division of the MCA supply the frontal and superior parietal cortex.
False
An embolus occluding the stem of the MCA often leads to the development of complete MCA syndromes.
True
When an MCA infarction affects the dominant hemisphere, global aphasia is found.
True
In MCA occlusion at its origin with limited distal collaterals, dysarthria is common due to facial weakness.
False
Anosognosia, constructional apraxia, and neglect are found in cases where the nondominant hemisphere is affected by MCA infarction.
True
Limited distal collaterals can lead to clinical findings such as contralateral hemiplegia and homonymous hemianopia in MCA occlusion.
True
Transfer perfusion techniques are essential for evaluating complete MCA syndromes.
False
Cortical collateral blood flow is a key factor responsible for many partial syndromes seen in MCA occlusion.
True
In MCA occlusion situations, gaze preference typically lasts for a week to the ipsilateral side.
False
Study Notes
Middle Cerebral Artery (MCA)
- MCA divides into superior and inferior divisions (M2 branches) in the sylvian fissure
- Inferior division branches supply the inferior parietal and temporal cortex
- Superior division branches supply the frontal and superior parietal cortex
Clinical Findings of MCA Occlusion
- Contralateral hemiplegia, hemianesthesia, homonymous hemianopia, and gaze preference to the ipsilateral side
- Dysarthria due to facial weakness
- Global aphasia if the dominant hemisphere is involved
- Anosognosia, constructional apraxia, and neglect if the nondominant hemisphere is affected
Anterior Cerebral Artery (ACA)
- ACA gives rise to several deep penetrating branches that supply the anterior limb of the internal capsule, anterior perforate substance, amygdala, anterior hypothalamus, and the inferior part of the head of the caudate nucleus
- Occlusion of the proximal ACA is usually well tolerated due to collateral flow through the anterior communicating artery and collaterals through the MCA and PCA
- Occlusion of a single A2 segment results in contralateral symptoms
CT Angiography (CTA)
- Allows visualization of the cervical and intracranial arteries, intracranial veins, aortic arch, and even the coronary arteries in one imaging session
- Can identify carotid disease and intracranial vascular occlusions
- Can demonstrate deficits in brain perfusion produced by vascular occlusion and predict the region of infarcted brain and the brain at risk of further infarction
Test your knowledge of cerebral arteries and brain regions with a diagram quiz showing the distribution of the anterior cerebral artery and principal regions of the brain. Identify important structures and their relationships on the medial aspect of a cerebral hemisphere.
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