MCA (Middle Cerebral Artery) Stroke

What is an MCA stroke?

An MCA stroke is a stroke that affects the middle cerebral artery (MCA) in your brain.

The middle cerebral artery is one of the biggest blood vessels in your brain. It’s connected to your carotid artery and supplies blood to the areas of your brain that control your ability to use your senses, move and use language. The MCA is the blood vessel that strokes most commonly affect.

An MCA stroke happens when your middle cerebral artery is blocked by a blood clot.

What are MCA stroke symptoms?

Some of the most common MCA stroke symptoms include:

• Weakness or paralysis on one side of your face and body
• Sudden worsening or loss of your senses (including vision, hearing, smell, taste and touch)
• Slurred or garbled speaking (dysarthria)
• Aphasia (trouble speaking or a complete loss of speech)
• Neglect (not noticing things on one side, usually your left)
• Loss of coordination or clumsiness (ataxia)

The MCA divides into branches on the left and right sides of your brain. These separate branches supply blood to each of your brain’s halves (hemispheres). Each hemisphere of your brain controls the opposite side of your body. So, if the stroke affects the left side of your brain, you’ll experience symptoms on your right side. And if the stroke damages tissues in the right side of your brain, you’ll have symptoms on your left side.

Strokes in the left side of the brain cause language problems (aphasia) in most people. Strokes on the right may make you neglect the left side of your body.

What are the warning signs of an MCA stroke?

Middle cerebral artery strokes can cause many different symptoms. To recognize the warning signs of a stroke in yourself or a loved one, remember the acronym BE FAST:

• Balance: Watch for a sudden loss of balance.
• Eyes: Look out for sudden vision loss or changes in one or both eyes.
• Face: Smile. Look for a droop on one or both sides of your face.
• Arms: Raise both arms. If you’re having a stroke, one arm may not move or will be very weak and sag.
• Speech: You might slur your speech or have trouble choosing the right words.
• Time: Time is critical — call for help immediately. If possible, look at your watch, phone or a clock to track when symptoms start. Telling a healthcare provider when symptoms began can help them know which treatment options are best for you.

Transient ischemic attack

A transient ischemic attack (TIA) — sometimes called a “mini-stroke” — is like a stroke, but the effects are temporary. These are often warning signs that a person has a very high risk of having a true stroke soon. A person who has a TIA needs emergency medical care as quickly as possible.

What causes MCA strokes?

MCA strokes are ischemic strokes. They happen when a blood clot blocks your middle cerebral artery. Health conditions that increase your risk of blood clots can include:

• High cholesterol (hyperlipidemia)
• Clotting disorders
• Atherosclerosis (hardened arteries)
• Atrial fibrillation (especially when sleep apnea causes it)
• Heart defects (including atrial septal defect and ventricular septal defect)

Risk factors

Anybody can have a stroke, but some groups have a higher risk, including people who:

• Smoke or use other forms of tobacco or nicotine (like vaping)
• Are older than 65
• Use recreational or nonprescription drugs
• Don’t have regular access to healthcare
• Have a history of strokes in their biological families
• Don’t get enough physical activity

Having certain health conditions can increase your stroke risk, including:

• High blood pressure (hypertension)
• High cholesterol (hyperlipidemia)
• COVID-19
• Diabetes
• Alcohol use disorder
• Obesity

How is an MCA stroke diagnosed?

A healthcare provider will diagnose an MCA stroke with a neurological exam, a physical exam and some tests. Providers in the emergency room may diagnose a stroke if emergency services transport you to the ER.

Your provider will use some of the following tests to confirm that you’ve had a stroke:

• CT scan
• CT angiogram
• Electrocardiogram (EKG)
• MRI
• Magnetic resonance angiogram (MRA)
• Cerebral angiogram
• Blood tests

What are MCA stroke treatments?

Your healthcare providers will work to restore normal blood flow to your brain as fast as possible to reduce your risk of permanent brain damage and death.

Your providers will break up or remove the blood clot. You’ll need thrombolytic medications (clot-busting medications) like tissue plasminogen activator (tPA). You may need surgery (usually a mechanical thrombectomy) to break up and remove the clot. Your providers may also give you medications to manage your blood pressure.

Get emergency treatment right away if you think you’re having a stroke. Providers can only use some treatments (like tPA) within a certain amount of time after a stroke starts.

Your providers will tell you exactly which treatments are best for you and what to expect.

Middle cerebral artery stroke rehabilitation

Stroke rehab is an important part of stroke treatment. You’ll need rehab to help you adjust to changes in your brain and body after a stroke. You may need to regain abilities you had before or adjust to new or different disabilities. You might need a combination of:

• Cognitive rehab to help improve your memory, concentration and other mental abilities.
• Speech therapy to regain or improve your language and speaking abilities and control the muscles that help you talk, breathe, eat and swallow.
• Occupational therapy to help you safely complete your daily tasks, especially chores or activities that need precise body movements.
• Physical therapy to strengthen your muscles, improve your balance and regain the use of your arms and legs.

Can you prevent a middle cerebral artery stroke?

Maintaining your overall health is the best way to reduce your risk of an MCA stroke. In general, try to:

• Quit smoking.
• Manage your blood pressure, cholesterol and any health conditions you have.
• Eat plenty of healthy foods and maintain a weight that’s healthy for you.
• Get regular physical activity.

Visit a healthcare provider every year (or as often as they suggest). Many of the health conditions that can cause MCA strokes develop or build up over time. Some don’t cause symptoms you can feel or notice. For example, many people with high cholesterol or high blood pressure never sense anything wrong before they’re diagnosed. Your provider will help you catch and manage any warning signs before they increase your risk of a stroke.

What is the life expectancy after an MCA stroke?

It’s hard for experts to estimate an accurate MCA stroke survival rate. A stroke can be fatal, cause permanent disabilities and affect how long you live (your life expectancy). But there’s no one standard recovery timeline or outlook that’s accurate for everyone.

Middle cerebral artery stroke prognosis

What you can expect (the prognosis) after an MCA stroke depends on a few factors, including:

• How quickly it was treated
• Your overall health
• Your age

Most people take at least a few months to recover. Your provider will tell you what to expect. They’ll help you set recovery goals and expectations that fit your unique health and situation.

Recovering and rehabbing after a stroke is hard work. Once you and your provider finalize your treatment plan, follow it as closely as possible. In general, you should:

• Take your medications. Taking your medicine as often as your provider instructs will help your body heal.
• Go to your rehab and other therapy appointments. Tell your therapists if anything makes you feel unsafe or uncomfortable. Rehab is hard work, but you shouldn’t be in constant pain or discomfort.
• Remember your mental health. Depression and anxiety are extremely common after a stroke. You’re not weak or a quitter for feeling sad or upset. Your emotional health can be just as important as how your physical body is doing. Talk to your provider or a mental health professional if you feel like you need help processing anything during your recovery.

When should I go to the ER?

Call 911 (or your local emergency services number) if you think you’re experiencing stroke symptoms again. Another stroke has an even higher risk of being fatal or causing severe complications. Don’t wait to call for help.

People who’ve had a stroke have an increased risk of other potentially serious complications, including:

• Pulmonary embolism
• Heart attack
• Seizures
• Pneumonia
• Deep vein thrombosis (DVT)

Call emergency services or go to the ER if you think you’re experiencing any symptoms of these complications.

Which questions should I ask my healthcare provider?

• Which medications will I need and how do I take them?
• Which kinds of rehab will I need?
• What’s my risk of another stroke in the future?
• Are there any support services or resources you recommend?

What is the difference between an MCA stroke and an ACA stroke?

MCA and ACA strokes are both strokes. The difference is which blood vessel in your brain they affect. The MCA is your middle cerebral artery. It’s divided into branches on each side of your brain. Your anterior cerebral artery (ACA) is closer to the front of your skull. “Anterior” is the medical term for front or front-facing. Unlike MCA strokes, ACA strokes may affect your ability to control and use your legs.

Both of these strokes can share causes and symptoms, and both can be fatal. You won’t be able to tell the difference between them until a healthcare provider identifies which blood vessel is blocked or damaged with imaging tests. Call 911 (or your local emergency services number) immediately if you think you’re experiencing any kind of stroke symptoms.