Middle Cerebral Artery (MCA)

Infarcts and ischemic events are more common in the middle cerebral artery
than in the anterior or posterior cerebral arteries, at least in part because of the
relatively large territory supplied by the middle cerebral artery. MCA infarcts
occur in the following three general regions:
1. Superior division
2. Inferior division
3. Deep territory
Proximal MCA occlusions affecting all three of these regions are called
MCA stem infarcts. The most common deficits seen with infarcts of left or
right MCA territories are summarized in. Knowledge of the MCA infarcts are relatively common.
Deficits such as aphasia, hemineglect,
hemianopia, and face–arm or face–arm–leg sensorimotor loss are described
further in. Large MCA territory infarcts
often have a gaze preference toward the side of the lesion, especially in the acute period, shortly after
onset.
Other combinations not listed in Table 10.1, such as superior plus inferior
division infarcts sparing deep territories, or superior division plus deep territories,
can occasionally occur. In addition, there are sometimes partial or
overlapping syndromes. Smaller cortical infarcts can also occur within one
territory, producing more focal deficits, such as monoparesis

Small, deep infarcts involving penetrating branches of the MCA or other

vessels are called lacunes, as we will discuss in. Certain characteristic
lacunar syndromes can often be distinguished on clinical
grounds from infarcts involving large blood vessel territories
deficits associated with each of these territories is clinically useful since

Unilateral Arm Weakness or Paralysis

OTHER NAMES: Brachial monoparesis or monoplegia; there are specific
names for different weakness patterns associated with peripheral
nerve injuries LOCATIONS RULED OUT: Unlikely anywhere along the corticospinal
tract (internal capsule, brainstem, spinal cord), because in that case
the face and/or lower extremity would also likely be involved. Rare
cases of foramen magnum tumors may initially affect one arm.
LOCATIONS RULED IN: Arm area of the primary motor cortex or peripheral
nerves supplying the arm.
SIDE OF LESION: Motor cortex: contralateral to weakness. Peripheral
nerves: ipsilateral to weakness.
ASSOCIATED FEATURES ALLOWING FURTHER LOCALIZATION:
Motor cortex lesions: There may be associated upper motor
neuron signs, cortical sensory loss, aphasia , or
subtle involvement of the face or leg. Occasionally, none of
these are present. The weakness pattern may be incompatible
with a lesion of peripheral nerves. For example, marked weakness of all finger, hand, and
wrist muscles with no sensory loss and normal proximal
strength does not occur with peripheral nerve lesions.
Peripheral nerve lesions: There may be associated lower motor
neuron signs. Weakness and sensory loss may be compatible
with a known pattern for a peripheral nerve lesion
.
COMMON CAUSES:
Motor cortex lesion: Infarct of a small cortical branch of the
middle cerebral artery, or a small tumor, abscess, or the like.
Peripheral nerve lesion: Compression injury, diabetic neuropathy,
and so on.