A type of stroke that blocks the middle cerebral artery in the brain is called a middle cerebral artery (MCA) stroke. In general, this type of stroke is ischemic (caused by blood clots). It is also considered a medical emergency, and you should call 911 or go to the nearest emergency room (ER) if you experience symptoms.
Furthermore, the middle cerebral artery is one of the largest blood vessels in the brain. It is also connected to the carotid artery that supplies the areas of the brain responsible for the ability to use senses, move, and use language. In people with strokes, the MCA blood vessel is usually affected.
Generally, this type of stroke is very common and accounts for about 50% of all ischemic strokes.
Symptoms
In most cases, people who develop MCA stroke experience the following symptoms. Check the most common symptoms of MCA stroke below:
- Weakness or paralysis on one side of the face and body
- Sudden worsening or loss of the senses (including hearing, smell, taste, touch, and vision)
- Dysarthria (slurred speech)
- Aphasia (difficulty speaking or a complete loss of speech)
- Ataxia (loss of coordination or clumsiness)
- Neglect (people who experience this symptom usually are not able to notice things on their left side)
In normal circumstances, the MCA divides into branches on the left and right sides of the brain. Furthermore, these branches supply blood to each part of the brain (also known as hemispheres). Each hemisphere of the brain controls the opposite side of the body. For instance, if a stroke negatively affects the left side of the brain, you will notice symptoms on the right side of the body. However, when a stroke happens in the left side of the brain, people experience language problems.
Warning Signs
Typically, MCA strokes cause multiple symptoms in different parts of the body. However, to recognize signs of a stroke in yourself or a loved one, remember the acronym BE FAST. It means:
- Balance – Sudden loss of balance
- Eyes – Sudden loss of vision or changes in one or both eyes
- Face – Look for a drop on one or both sides of the face while smiling
- Arms – People with stroke are not able to move one arm, or it can be very weak
- Speech – Slurred speech or difficulty choosing the right words
- Time – In general, strokes are a medical emergency, and without immediate treatment, they may lead to permanent damage to the brain
Another warning sign of strokes is a transient ischemic attack (TIA). This condition is also called a “mini-stroke” because it causes similar symptoms but for a short period. Most of the time, people who experience TIA are at increased risk of developing a true stroke soon. That’s why people need immediate medical care if any of them occurs.
Causes and Risk Factors
All MCA strokes are ischemic strokes that are caused by a blood clot that restricts blood flow to the brain’s middle cerebral artery. Check below some health conditions that significantly increase the risk of a blood clot formation:
- Atherosclerosis (plaque buildup in the arteries)
- Atrial fibrillation (especially when it is caused by sleep apnea)
- Clotting disorders
- Hyperlipidemia (high cholesterol)
- Heart defects (these include atrial septal defect and ventricular septal defect)
While anyone may develop MCA strokes, physicians have identified some factors that could elevate your risk of developing them. Check some examples below:
- Smoking and other tobacco or nicotine forms (such as vapes)
- Age – Older adults (over 65 years old) are more prone to MCA stroke.
- The use of recreational and nonprescription medicines
- Do not have access to regular healthcare
- A history of strokes in their biological families
- Lack of physical activity
Furthermore, people who already have the following conditions are also at increased risk for MCA stroke. These include COVID-19, diabetes, alcohol use disorder, obesity (excessive body weight), high cholesterol, and hypertension (high blood pressure).
What Are The Possible Complications of MCA Stroke?
Those who develop MCA stroke may also experience some complications, especially if they do not get treatment right away. Check some of them below:
- Brain edema or swelling
- Decompressive hemicraniectomy – This surgery is often used to relieve pressure from severe swelling.
- Cardiovascular problems – These include myocardial infarction (heart attack), atrial fibrillation, and others.
- Hemorrhagic transformation – This complication occurs when the damaged area of the brain bleeds.
- Contralateral hemiplegia – This is weakness or paralysis that occurs on the opposite side of the body. Mostly, it affects the face and one arm.
- Aphasia (impaired speech production)
- Visual field loss
- Dysphagia (swallowing problems) – This complication affects about 50% of people with MCA strokes, and it also increases the risk of aspiration and malnutrition.
- Loss of sensation, coordination, and balance (sensory loss and ataxia)
- Infections – These include pneumonia, urinary tract infections (UTIs), and others.
- Mental disorders – For example, depression, memory loss, anxiety, and others.
- Epilepsy
- Recurrent strokes
- Chronic incontinence (loss of bladder control)
The previous list does not contain a full list of MCA stroke complications. In any case, you can talk with your physician about ways to reduce the risk or even prevent them.
How to Prevent MCA Stroke?
One of the best ways to reduce the risk of this condition is to maintain overall health. Examples include:
- Stop smoking – Do not hesitate to visit a doctor if you have problems with smoking cessation.
- Manage chronic health conditions – For example, high cholesterol, hypertension, diabetes, and others.
- Eat plenty of healthy foods
- Regular physical exercise – Usually, it is recommended to perform 30 minutes of physical exercise per day, at least 5 days a week. Furthermore, physical exercises may also help maintain a healthy weight.
Diagnosis
Most of the time, the diagnosis of MCA stroke begins with a physical and neurological examination to check for irregularities linked to the disease. Physicians may also ask some questions about your family history and symptoms. Usually, they use the following tests to confirm or exclude MCA strokes. For example:
- CT angiogram
- CT (computerized tomography) scans
- Electrocardiogram (ECG or EKG)
- MRA (magnetic resonance angiogram)
- MRI (magnetic resonance imaging)
- Cerebral angiogram
- Blood tests
Treatment
The treatment goal is to restore normal blood flow to the brain as fast as possible to prevent serious complications (such as permanent brain damage). First, doctors will break up or remove the blood clot and prescribe thrombolytic medicines (also called clot-busting medicines), such as Plasminogen activator (tPA). Some people with MCA stroke may need surgery (commonly a mechanical thrombectomy) to remove the clot. After surgery, doctors often prescribe medicines to control blood pressure.
Rehabilitation
This is an important part of the stroke treatment that helps people adjust to changes in their brain and body after an MCA stroke. In more severe cases, people need to regain abilities they had before this condition. Thus, doctors may recommend the following options. Examples include:
- Cognitive rehabilitation – This treatment often helps improve memory, concentration, and other mental abilities.
- Speech therapy – During this therapy, doctors help people regain or improve their language and speaking abilities. It may also help learn to control the muscles that are involved in talking, breathing, and swallowing.
- Occupational therapy – It is usually used to help people perform activities that require precise body movements.
- Physical therapy – This therapy is used to strengthen muscles and improve balance.
Frequently Asked Questions
What is the life expectancy after an MCA stroke?
Usually, it is difficult to estimate an accurate MCA stroke survival rate. Sometimes, this condition can be fatal or cause permanent damage to the brain. Moreover, there is no one standard recovery timeline or outlook that is accurate for everyone. For more details, discuss it with your physician.
When should I go to the ER?
If you think you or a loved one has stroke symptoms, immediately call 911 or go to the nearest emergency room (ER). It is very important to get treatment as soon as possible. Otherwise, there is an increased risk of developing the following life-threatening health conditions. These include:
- Pulmonary embolism (PE)
- Heart attack (also known as a myocardial infarction)
- Seizures
- Pneumonia
- Deep vein thrombosis (DVT)
What is the difference between an MCA stroke and an ACA stroke?
Both health conditions are types of stroke, but they have some differences between them. The MCA stroke negatively affects the middle cerebral artery, which is divided into branches on each side of the brain. However, in people with ACA stroke, the anterior cerebral artery is affected. Furthermore, this artery is closer to the front of the skull. Most of the time, people with ACA strokes experience problems with controlling their legs. If you have additional questions, ask your healthcare provider.
