Middle Cerebral Artery (MCA) Syndrome

The clinical picture vary depends on the site of occlusion and availability of collaterals.It is characterized by:

• Contralateral hemiplegia affecting the face and arm more than the leg.
• Contralateral hemianesthesia affecting the face and arm more then leg. There is also loss of cortical sense like stereognosis, discrimination and tactile extinction.
• Contralateral homonymous hemianopia or inferior quadrantanopia.
• Aphasia when dominant lobe is involved
• Inattention, neglect, denial of illness and apractic syndromes mainly with nondominant hemispheric lesions.
• Paresis and apraxia of conjugate gaze to the opposite side.
• Alexia and agraphia (Left angular gyrus lesion)
• Gerstmann'ssyndrome (Fingeragnosia, acalculia dysgraphia and right-left disorientation).Infarction in the nondominant hemisphere result in it

Perioral and distal upper limb sensory dysfunction is called as cheiro-oral syndrome,may occur . 

Ataxic hemiparesis with cheiro-oral syndrome is sometime seen contralateral posterior capsular infarction 

Rarely, nondominant infarction may result in  an acute confusional state and acute agitated delirium with affective and autonomic excitement, delusions, and hallucinations .

Lesions of either hemisphere may result in  contralateral homonymous hemianopia or contralateral homonymous inferior quadrantanopia.

Cataleptic posturing in isolation from other manifestations of the catatonic syndrome is also mentioned in association with MCA territory infarction 

Symptoms of main artery occlusion:

• Coma at the  onset.
• Contralateral hemiplegia affecting  face and arm more than leg
• Contarlateral hemihyposthesia with cortical sensory loss in upperlimb. There is also loss of cortical sense like stereognosis, discrimination and tactile extinction.
• Contralateral homonymous hemianopia.
• Aphasia and agraphia in left sided lesions.

Capsular Branch Occlusion: (Lenticulo striate artery)

• Contralateral complete hemiplegia affecting the upper and lower limbs to the same extent
• Contralateral hemihyposlhesia of subcortical type.
• Contralateral hemianopia may occur.
• No loss of consciousness or aphasia.

Cortical branch occlusion

Frontal Branches occlusion:

• Facio-brachial monoplegia.
• Motor aphasia and agraphia in left-sided lesions.

Parietal vessel occlusion:

• Cortical sensory loss in the upper limb.
• Lower.quadrantic homonymous hemianopia
• Sensory aphasia (alexia) and apraxia in left sided lesions.

Temporal  vessel occlusion

• Upper quadrantic homonymous hemianopia.
• Sensory aphasia (auditory agnosia).