Master Middle Cerebral Artery Stroke Assessment with Picmonic for Medicine

An MCA stroke involving one cerebral hemisphere may result in contralateral weakness or paralysis of the face and upper extremity due to involvement of the lateral primary motor cortex.

An MCA stroke involving one cerebral hemisphere may result in contralateral sensory loss of the face and upper extremity due to involvement of the lateral primary sensory cortex.

In an MCA stroke, patients may present with contralateral homonymous visual field defects, commonly homonymous hemianopsia, or loss of the same visual field in both eyes opposite the side of the stroke. For instance, a right-sided MCA stroke may cause loss of the left visual fields in both eyes. This occurs due to involvement of visual pathways supplying the contralateral visual field.

In an MCA stroke, patients may also present with ipsilateral conjugate gaze deviation in which the eyes deviate, or look, toward the side with the brain lesion and away from the side of hemiplegia. For instance, if the MCA occurs in the right hemisphere, as seen in this Picmonic, the eyes will deviate horizontally to the right (away from the left-sided facial and upper limb hemiparesis). This commonly occurs due to involvement of the frontal eye fields, which disrupt normal voluntary eye motor control.

An MCA stroke involving the dominant cerebral hemisphere, usually the left hemisphere, may present with aphasia, such as Broca’s or Wernicke’s aphasia. When Broca’s area is affected, patients may develop expressive aphasia with relatively preserved speech comprehension and non-fluent, halting, laborious, and effortful speech. When the Wernicke’s area is affected, patients may develop receptive aphasia, characterized by impaired language comprehension and fluent, but incoherent speech that may include neologisms (made-up words) and jargon.

An MCA stroke involving the nondominant hemisphere, usually the right hemisphere, may present with hemineglect, in which the patient may neglect or ignore the contralateral side of the body and surrounding environment.