Middle Cerebral Artery CVA

1. What is the most common cause of occlusion of the superior division of the MCA?
2. What is the typical presentation of a superior MCA CVA? What sort of aphasia is seen if the dominant hemisphere is affected?
3. What is seen in a nondominant lesion of the superior MCA?
4. What is the typical presentation of an inferior MCA CVA?
5. What is seen with a dominant vs. nondominant hemisphere inferior MCA CVA?

Answers:
1. Embolus.
2. Sensory and motor deficits in the contralateral face and arm>leg, head and eyes deviated toward side of infarct. Initially there is decreased muscle tone that gradually increases over days or weeks. With dominant hemisphere involvement, initially global aphasia is seen, then Broca's.
3. Deficits in spacial perception, hemineglect, constructional apraxia, dressing apraxia.
4. Superior quadrantanopia or homonymous hemianopsia.
5. Dominant results in Wernicke's aphasia. Nondominant results in left visual neglect.