Thrombosis of the Superior branch of middle cerebral aery leads to:
* In the Syln fissure, the MCA in most patients divides into superior and inferior divisions (M2 branches). * Branches of the inferior division supply the inferior parietal and temporal coex, Branches from the superior division supply the frontal and superior parietal coex. * Hence due to damage of the blood supply of the Broca's area the main feature shall be motor aphasia. ENTIRE MCA is occluded at its origin (blocking both its penetrating and coical branches) - clinical findings are 1) contralateral hemiplegia, 2) hemianesthesia, 3)Homonymous hemianopia, 4) A day or two of gaze preference to the ipsilateral side. 5)Dysahria is common because of facial weakness. Dominant hemisphere is involved- global aphasia is present Nondominant hemisphere is affected- anosognosia, constructional apraxia, and neglect are found. PAIAL SYNDROME A)Brachial syndrome- embolic occlusion of a single branch include hand, or arm and hand, weakness alone . B)Frontal opercular syndrome-. facial weakness with nonfluent (Broca) aphasia, with or without arm weakness C)Proximal superior division of MCA. A combination of 1)sensory disturbance, 2) motor weakness, and 3) nonfluent aphasia suggests that an embolus has occluded the proximal superior division and infarcted large poions of the frontal and parietal coices D)inferior devision OF MCA IN DOMINANT HEMISPHERE- -If a fluent (Wernicke's) aphasia occurs without weakness, the inferior division of the MCA supplying the posterior pa (temporal coex) of the dominant hemisphere is probably involved. other menifestations -Jargon speech and an inability to comprehend written and spoken language are prominent -Contralateral, homonymous superior quadrantanopia. IN NON DOMINANAT HEMISHERE-Hemineglect or spatial agnosia without weakness indicates that the inferior division of the MCA in the nondominant hemisphere is involved. E)Occlusion of a lenticulostriate vessel produces small-vessel (lacunar) stroke within the internal capsule . This produces pure motor stroke or sensory-motor stroke contralateral to the lesion. F)Ischemia within the genu of the internal capsule- 1) primarily facial weakness followed by arm and then leg weakness as the ischemiamoves posterior within the capsule., 2) Clumsy hand, dysahria lacunar syndrome). The contralateral hand may become ataxic, and dysahria will be prominent G) Lacunar infarction affecting theglobus pallidus and putamen -parkinsonism and hemiballismus.
Motor aphasia
Urinary retention
Bitemporal hemianopia
Grasp reflex
Stroke and TIA