Clinical Syndromes Large Vessel Occlusion

MIDDLE CEREBRAL ARTERY

Anatomy

Lateral surface of cerebral hemisphere

Motor Sensory

---Middle cerebral artery

The middle cerebral artery is the largest branch of the internal carotid artery. It gives off (1) deep branches (perforating vessels - lenticulostriate) which supply the anterior limb of the internal capsule and part of the basal nuclei. It then passes out to the lateral surface of the cerebral hemisphere at the insula of the lateral sulcus. Here it gives off cortical branches (2) temporal, (3) frontal, (4) parietal.

Clinical features

The middle cerebral artery may be occluded by embolus or thrombus. The clinical picture depends upon the site of occlusion and whether dominant or non-dominant hemisphere is affected.

Occlusion at the insula

Contralateral hemiplegia (leg relatively spared) Contralateral hemianaesthesia and hemianopia All cortical branches are involved - Aphasia (dominant)

Neglect of contralateral limbs Dressing difficulty

(non-dominant)

When cortical branches are affected individually, the clinical picture is less severe, e.g. involvement of parietal branches alone may produce Wernicke's dysphasia with no limb weakness or sensory loss.

The deep branches (perforating vessels) of the middle cerebral artery may be a source of haemorrhage or small infarcts (lacunes - see later).

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