Not seen in case of hemorrhage in MCA territory: March 2005

Ans. D: Urinary incontinence The MCA is by far the largest cerebral aery and is the vessel most commonly affected by cerebrovascular accident (CVA). The MCA supplies most of the outer convex brain surface, nearly all the basal ganglia, and the posterior and anterior internal capsules. Patients with middle cerebral aery stroke syndrome (MCA stroke syndrome) may have some basic physical findings, as follows: Main trunk occlusion of either side yields contralateral hemiplegia, eye detion toward the side of the MCA infarct, contralateral hemianopia, and contralateral hemianesthesia. Trunk occlusion involving the dominant hemisphere causes global aphasia, whereas involvement of the nondominant hemisphere causes impaired perception of deficits (anosognosia) resulting from the stroke and more qualitative deficits of speech. Superior division infarcts lead to contralateral deficits with significant involvement of the upper extremity and face and paial sparing of the contralateral leg and foot. Inferior division infarcts of the dominant hemisphere lead to Wernicke's aphasia. Such infarcts on either side yield a superior quadrantanopsia or homonymous hemianopia, depending on the extent of infarction. Right inferior branch infarcts also may lead to a left visual neglect. Finally, resultant temporal lobe damage can lead to an agitated and confused state Dysahria is common because of facial weakness.