Could You Recognize the Symptoms of a Middle Cerebral Artery Stroke? (2023)

A middle cerebral artery (MCA) stroke occurs when blood flow from the largest artery of the brain is suddenly interrupted (ischemia) or altogether stopped (infarction). The loss of blood flow causes tissue death, leading to serious and potentially permanent brain injury.

MCA strokes aremost often the result of a blood clot that travels from outside the brain, such as from the heart or carotid artery, and causes a partial or complete blockage of the artery.

While an MCA stroke is serious, people suffering one are more likely to survive than someone with a hemorrhagic stroke, which is caused by a ruptured artery.

This article takes a closer look at the MCA as well as the symptoms and causes of MCA strokes. Is also explains how MCA strokes are diagnosed and treated and what to expect during rehabilitation.

Could You Recognize the Symptoms of a Middle Cerebral Artery Stroke? (1)

What Is the Middle Cerebral Artery?

The arteries in your brain come in symmetrical pairs. Each one has a left and right artery. The MCAs are vital blood vessels that branch off from the internal carotid arteries.

The internal carotid arteries are branches of the common carotid arteries. Those are large blood vessels in your neck.

The MCA is the largest branch of the internal carotid arteries. It can be involved in large strokes.

What Does the MCA Do?

Arteries in the brain carry blood that’s rich in oxygen and nutrients to the brain. Each artery supplies a different section of the brain. That section is called the “territory” of that artery.

The MCAs supply a large territory in the brain that includes the:

  • Parietal lobe: Processes sensory information related to touch, taste, and temperature
  • Temporal lobe: Processes audio and encodes memory
  • Internal capsule: Aids communication between areas of the brain
  • A portion of the frontal lobe: Important for movement, expressive language, and the ability to work toward a goal

When blood flow to these areas is impaired, they have a hard time doing their jobs.

Middle Cerebral Artery Anatomy and Function


MCA strokes happen when the MCA is blocked or ruptured and blood flow to the MCA’s territory is interrupted.

The MCA is the largest branch of the internal carotid arteries. It carries blood—which contains oxygen and nutrients—to several critical areas of the brain. The lack of blood flow kills brain cells and impairs function in that region.

MCA Stroke Symptoms

MCA strokes are the most common type. Their symptoms are the ones people usually associate with strokes,such as:

  • Weakness and/or numbness on one side
  • Facial droop
  • Language deficits

An MCA stroke may also cause:

  • Sensory deficits
  • Visual defects

These affect the opposite side of the body from the artery. So a stroke in the right MCA causes symptoms on the left side of the body.

How to Recognize a Stroke and What to Do

(Video) Middle Cerebral Artery Stroke


Click Play to Learn All About MCA Strokes

This video has been medically reviewed by Chris Vincent, MD.


The MCA is a large blood vessel. Large-vessel strokes affect more of the brain than strokes in small vessels. If the MCA itself is blocked, the result is a large-vessel stroke that affects its entire territory.

If only a small branch of the MCA is blocked, it causes a small-vessel stroke. This impacts a small section of the MCA’s territory and is often less serious.

MCA strokes are generally caused by a blood clot that travels from outside the brain. Typically, it’s from the heart or carotid artery. Then the clot gets lodged in the MCA and blocks blood flow.

This is called an embolic stroke. When the clot originates in the arteries of the brain, it’s called thrombotic.

Risk factors for MCA strokes include:

  • Heart disease
  • Carotid artery disease
  • General stroke risk factors such as high cholesterol, hypertension, and diabetes


MCA strokes are common and their symptoms are well known. A stroke in the left MCA causes symptoms on the right side of your body and visa-versa.

Large-vessel strokes like MCA strokes affect large areas of the brain. Sometimes, only a branch of the MCA is blocked and the stroke is less severe.

Blood clots that travel from the heart or carotid artery often cause MCA strokes.


MCA strokes are among the most easily recognized types of stroke.

Even so, your healthcare provider will likely use multiple labs and tests to confirm the diagnosis. These may include:

  • A neurological exam to determine affected brain regions
  • Electrocardiogram (EKG) to check electrical conduction of the heart, which may be irregular after a stroke
  • Lumbar puncture (spinal tap) to check for hemorrhagic stroke (rupture of a weakened blood vessel)
  • Blood tests to look for known risk factors, including clotting disorders, high cholesterol, and diabetes
  • Computed tomography (CT) scan to quickly check for a brain bleed
  • Magnetic resonance imaging (MRI) to find a blood vessel blockage

Other tests and imaging may be performed depending on your symptoms.

Treatment and Rehabilitation

Urgent treatment may include:

  • Tissue plasminogen activator (TPA), a powerful blood thinner
  • Other blood thinners
  • Careful management of blood pressure, blood sugars, electrolytes, and fluids
  • Surgery to remove pressure on vital brain regions

Rehabilitation after a stroke can be intensive and prolonged. It may involve physical, occupational, and speech therapy.


Blocks or ruptures in the MCA lead to MCA strokes. The resulting loss of blood, oxygen, and nutrients can cause brain damage and impair function in the regions that get blood from the MCA.

(Video) Middle Cerebral Artery Stroke Syndromes | MCA Stroke Syndromes (With Gerstmann Syndrome & Lesions!)

MCA strokes are often large unless only a branch of it is blocked, in which case they’re smaller and less serious. Symptoms of MCA strokes are the ones most people associate with strokes and have to do with the regions affected.

MCA strokes are often caused by blood clots that travel from the heart or carotid artery. They’re diagnosed using a neurological exam, blood tests, and imaging.

Treatment includes blood thinners, surgery to relieve pressure, and management of several vital signs. Recovery may involve multiple types of therapy, depending on the symptoms. Recovery from an MCA stroke may take some time, particularly if the entire MCA was blocked, resulting in a large stroke.

Long-term recovery and rehabilitation may take months or even years. However, a good recovery is possible even from very serious strokes. Most people who have an MCA stroke are able to regain some function.

Frequently Asked Questions

  • What is a middle cerebral artery stroke?

    A middle cerebral artery stroke occurs when the middle cerebral artery (the largest branch of the internal carotid artery) is blocked. The middle carotid artery supplies parts of the brain responsible for movement and feeling in the trunk, limbs, and face.

  • What are symptoms of a middle cerebral artery stroke?

    Middle cerebral artery (MCA) strokes cause the same symptoms that people commonly associate with any stroke, namely:

    • Unilateral (one-sided) weakness and/or numbness
    • Unilateral facial drooping
    • Unilateral vision changes
    • Difficulty speaking
    • Loss of ability to understand or express speech
  • What causes a middle cerebral artery stroke?

    A middle cerebral stroke can either be hemorrhagic (caused by a brain bleed) or ischemic (caused by a blockage). Older age, genetics, race, high blood pressure, smoking, obesity, and diet contribute to both. Risk factors for an ischemic stroke also include high cholesterol, diabetes, coronary artery disease, heart failure, and atrial fibrillation.

  • How is a middle cerebral artery stroke diagnosed?

    The diagnosis starts with either a computed tomography (CT) or magnetic resonance imaging (MRI) scan of the brain, followed by a CT or MR angiogram of the head and neck. Lab tests may be performed as well as other diagnostic procedures such as an electrocardiogram (ECG) or thoracic echocardiogram.

  • How do you treat a middle cerebral artery stroke?

    (Video) Middle Cerebral Artery Stroke Syndromes | Anatomy | Clinical features |

    In the event of an ischemic stroke, an intravenous drug called tissue plasminogen activator (TPA) is used to break up the clot blocking the artery; in some cases, catheters and stents may be used to remove the clot and restore blood flow. Hemorrhagic strokes usually require surgery to relieve intracranial pressure caused by bleeding.

  • How do you know if you are having a stroke?

    The acronym BE FAST is often used by health educators to describe stroke symptoms affecting balance, eyes, face, arm, speech, and time. Call 911 or seek emergency care if you or someone else experiences:

    • Sudden loss of balance on one side
    • Vision changes in one eye or double vision
    • One-sided facial drooping
    • Loss of function or sensation in one arm
    • Slurred speech
    • Trouble finding a word or getting words out

    Learn More:Is It a Migraine or a Stroke?

9 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

  1. National Heart, Lung, and Blood Institute. What is a stroke?.

  2. Chandra A, Li WA, Stone CR, Geng X, Ding Y. The cerebral circulation and cerebrovascular disease I: anatomy. Brain Circ. 2017;3(2):45-56. doi:10.4103/bc.bc_10_17

  3. Dharmasaroja PA, Muengtaweepongsa S. Outcomes of patients with large middle cerebral artery infarct treated with and without intravenous thrombolysis. J Neurosci Rural Pract. 2016;7(1):36-39.doi:10.4103/0976-3147.172149

  4. Kleindorfer DO, Towfighi A, Chaturvedi S, et al. 2021 Guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American Heart Association/American Stroke Association. Stroke. 2021;52(7):e364-e467. doi:10.1161/STR.0000000000000375

    (Video) Stroke Syndromes: MCA, ACA, ICA, PCA, Vertebrobasilar Artery Strokes | Pathophysiology

  5. Rivkin MJ, Bernard TJ, Dowling MM, Amlie-Lefond C. Guidelines for urgent management of stroke in children. Pediatr Neurol. 2016;56:8-17. doi:10.1016/j.pediatrneurol.2016.01.016

  6. Centers for Disease Control and Prevention.Stroke facts.

  7. Mendelson SJ, Prabhakaran S. Diagnosis and management of transient ischemic attack and acute ischemic stroke: a review. JAMA. 2021;325(11):1088-1098. doi:10.1001/jama.2020.26867

  8. Greenberg SM, Ziai WC, Cordonnier C, et al. 2022 Guideline for the management of patients with spontaneous intracerebral hemorrhage: a guideline from the American Heart Association/American Stroke Association. Stroke. 2022;53(7):e282-e361. doi:10.1161/STR.0000000000000407

  9. Aroor S, Singh R, Goldstein LB. BE-FAST (Balance, Eyes, Face, Arm, Speech, Time): reducing the proportion of strokes missed using the FAST mnemonic. Stroke. 2017;48(2):479-481. doi:10.1161/STROKEAHA.116.015169

Could You Recognize the Symptoms of a Middle Cerebral Artery Stroke? (2)

By Heidi Moawad, MD
Heidi Moawad is a neurologist and expert in the field of brain health and neurological disorders. Dr. Moawad regularly writes and edits health and career content for medical books and publications.

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Could You Recognize the Symptoms of a Middle Cerebral Artery Stroke? ›

As described previously, MCA strokes typically present with the symptoms individuals associate most commonly with strokes, such as unilateral weakness and/or numbness, facial droop, and speech deficits ranging from mild dysarthria and mild aphasia to global aphasia.

How do you test for MCA stroke? ›

Diagnosis of an MCA stroke generally occurs using imaging such as CT or MRI to help pinpoint the area of the brain affected. Imaging is commonly performed within the first hour after an individual is admitted to the hospital as this allows medical staff to appropriately provide the necessary treatments.

What is a middle cerebral artery stroke? ›

Middle cerebral artery (MCA) stroke describes the sudden onset of a focal neurologic deficit resulting from hemorrhagic or ischemic disruption of the MCA's blood supply. The MCA is by far the largest cerebral artery and is the vessel most commonly affected by cerebrovascular accident (CVA).

What happens when the middle cerebral artery is blocked? ›

Embolism of the MCA

The arterial occlusion impedes perfusion of oxygenated blood to the brain parenchyma, resulting in an ischemic stroke causing cerebral edema and brain parenchyma tissue necrosis. As a general rule, a proximal occlusion will cause damage to a large surface area and be devastating.

What are the symptoms of middle cerebral artery stenosis? ›

  • Sudden numbness or weakness of the face, arm or leg, especially on one side of the body.
  • Sudden confusion.
  • Sudden trouble speaking.
  • Sudden trouble seeing in one or both eyes.
  • Sudden trouble walking.
  • Dizziness, loss of balance or coordination.
  • Sudden, severe headache with no known cause.

How is a cerebral stroke diagnosed? ›

A brain CT scan can show if there is bleeding in the brain or damage to the brain cells from a stroke. Magnetic resonance imaging (MRI) uses magnets and radio waves to create pictures of your brain. An MRI may be used instead of—or in addition to—a CT scan to diagnose a stroke.

What does right MCA stroke affect? ›

Right MCA stroke may reduce experience of pleasant emotions by altering brain activity in limbic and paralimbic regions distant from the area of direct damage, in addition to changes due to direct tissue damage to insula and basal ganglia.

What are the 5 warning signs of a stroke? ›

Call 9-1-1 immediately if any of these signs of stroke appear: Numbness or weakness in the face, arm, or leg; Confusion or trouble speaking or understanding speech; Trouble seeing in one or both eyes; Trouble walking, dizziness, or problems with balance; severe headache with no known cause.

Is a MCA aneurysm the same as a stroke? ›

A stroke occurs when there's a ruptured blood vessel in the brain or blood supply to the brain has been blocked. An aneurysm is the result of a weakened artery wall. Aneurysms cause bulges in your body, which may also rupture and subsequently bleed. They can affect any part of the body, including the brain and heart.

What are the symptoms of a stroke in the arteries? ›

Signs and symptoms of stroke include:
  • Trouble speaking and understanding what others are saying. You may experience confusion, slur words or have difficulty understanding speech.
  • Paralysis or numbness of the face, arm or leg. ...
  • Problems seeing in one or both eyes. ...
  • Headache. ...
  • Trouble walking.
Jan 20, 2022

What deficits are seen in middle cerebral artery occlusion? ›

Middle cerebral artery occlusion produces a contralateral hemiparesis and sensory loss of a cortical type. This is often accompanied by a hemianopia if the optic radiation is affected.

What areas are affected by middle cerebral artery stroke? ›

A stroke of the MCA is denoted as middle artery syndrome. presents with: contralateral sensory loss of the legs, arms, and lower two-thirds of the face due to tissue necrosis of the primary somatosensory cortex.

What is the prognosis for middle cerebral artery stroke? ›

Large territory middle cerebral artery strokes are devastating events that result in high rates of disability and death. In fact, nearly half of all stroke survivors never regain functional independence.

What gives off middle cerebral artery? ›

The middle cerebral artery arises within the interpeduncular fossa, from the internal carotid artery from the lateral angle of the circle of Willis.

What is anterior or middle cerebral artery stroke? ›

Anterior cerebral artery strokes occur in the territory of the anterior cerebral artery which involves the superior and medial part of the parietal lobe along with the midline of the frontal lobe. These are uncommon causes of ischemic infarctions, making up about 0.3%-4.4% of stroke cases in series reports.

What are the symptoms of MCA bifurcation aneurysm? ›

MCA aneurysms are the most common types of lesion in the intracranial artery wall, and frequently lead to headache, dizziness, ischemic infarction, neck pain and mass effect, while certain cases may also be asymptomatic (25).

Is there a way to detect a stroke before it happens? ›

Sudden weakness, numbness or incoordination of one side or part of the body, drooping of the face, sudden loss of vision in one eye or on one side, slurred speech, difficulty speaking or understanding speech, sudden onset dizziness or impaired walking or balance.

Can blood work show if you had a stroke? ›

Blood tests for stroke. There is no blood test that can diagnose a stroke. However, in the hospital, your doctor or nurse may do a series of blood tests to learn the cause of your stroke symptoms: Complete blood count (CBC).

What is the most common cause of MCA stroke? ›

MCA strokes are generally caused by a blood clot that travels from outside the brain. Typically, it's from the heart or carotid artery. Then the clot gets lodged in the MCA and blocks blood flow.

Does MCA stroke affect vision? ›

3 Homonymous hemianopia is a loss of the right or left halves of the visual field of both eyes (Figure 1a, 1b) and usually occurs as a result of a middle cerebral or posterior cerebral artery stroke affecting either the optic radiation or visual cortex of the occipital lobe (Figure 2).

What part of the brain does the middle cerebral artery supply? ›

The middle cerebral arteries supply the majority of the lateral surface of the hemisphere, except the superior portion of the parietal lobe (via the anterior cerebral artery) and the inferior portion of the temporal lobe and occipital lobe (via the posterior cerebral artery).

How long does your body warn you before a stroke? ›

Warning signs of an ischemic stroke may be evident as early as seven days before an attack and require urgent treatment to prevent serious damage to the brain, according to a study of stroke patients published in the March 8, 2005 issue of Neurology, the scientific journal of the American Academy of Neurology.

What are the warning signs of a stroke days before? ›

Some people will experience symptoms such as headache, numbness or tingling several days before they have a serious stroke. One study found that 43% of stroke patients experienced mini-stroke symptoms up to a week before they had a major stroke.

What is a silent stroke? ›

A silent stroke refers to a stroke that doesn't cause any noticeable symptoms. Most strokes are caused by a clot that blocks a blood vessel in the brain. The blockage prevents blood and oxygen from reaching that area, causing nearby brain cells to die.

Does MCA stroke affect memory? ›

The perception of music can be impaired after a stroke. This dysfunction is called amusia and amusia patients often also show deficits in visual abilities, language, memory, learning, and attention.

What is the most common site of MCA aneurysm? ›

As is generally known, the vast majority of the cerebral aneurysms are located in the anterior segment of the circle of Willis. In this segment the three most frequent topographies are: the supraclinoid segment of the internal carotid artery, the anterior communicating cerebral artery and the middle cerebral artery.

What comes first a stroke or aneurysm? ›

The weakness in the wall of a vessel leads to ballooning or bulging, which can eventually lead to a rupture of the wall. “When it ruptures,” Dr. Shekhtman says, “the blood comes out of the artery and damages whatever brain structures are near.” An aneurysm can lead to a stroke, but a stroke won't lead to an aneurysm.

What can be mistaken for stroke? ›

Some of the most common stroke mimics are seizures, migraine, fainting, serious infections and functional neurological disorder (FND). Once the person is diagnosed, they can have treatment or support to manage their symptoms.

What are the 4 types of strokes? ›

Different types of stroke
  • Ischaemic stroke.
  • Haemorrhagic stroke.
  • Transient ischaemic attack or TIA.

What are the most prominent symptoms following posterior cerebral artery occlusion? ›

Patients with a PCA stroke may present with only a headache and mild visual changes such as vision loss, diplopia, inability to see half of the view, or difficulty reading perceiving colors, or recognizing familiar faces.

What type of ischemic stroke has no single determined cause? ›

Strokes without a known cause are called cryptogenic.

Which cerebral artery problems in the distribution is most commonly associated with aphasia? ›

The most common problems—aphasia, apraxia, agnosia, and hemi-neglect, and other cognitive losses—occur in the areas of the brain supplied by the middle cerebral artery.

Does right MCA stroke affect speech? ›

Damage to these areas, for example, due to a right middle cerebral artery (MCA) stroke, can result in impaired prosodic function for both production and comprehension of speech.

Which artery is most affected by stroke? ›

Middle Cerebral Artery (MCA) Infarction

The middle cerebral artery (MCA) is the most common artery involved in stroke. It supplies a large area of the lateral surface of the brain and part of the basal ganglia and the internal capsule via four segments (M1, M2, M3, and M4).

Which direction is gaze preference with a middle cerebral artery occlusion? ›

Middle cerebral artery stroke

Ipsilateral hemianopsia. Gaze preference toward the side of the lesion.

Which stroke is more severe in the middle cerebral artery? ›

Strokes affecting the left side of the MCA may be more severe than those that affect the right. According to a 2022 study , those with left MCA strokes scored higher on the National Institutes of Health Stroke Scale, an assessment tool healthcare professionals use to assess the severity of a stroke.

Can MCA stroke be caused by trauma? ›

Traumatic occlusion of the middle cerebral artery (MCA) is a rare cause of cerebral infarct. We describe a case of MCA occlusion following blunt head trauma. The literature reports some 65 cases of MCA occlusion following non-penetrating blunt trauma to the head.

Can the middle cerebral artery be stented? ›

DISCUSSION. This case series confirms that primary stenting of the MCA can be performed with a high success rate and low periprocedural risks.

What is the presentation of a middle cerebral artery stroke? ›

As described previously, MCA strokes typically present with the symptoms individuals associate most commonly with strokes, such as unilateral weakness and/or numbness, facial droop, and speech deficits ranging from mild dysarthria and mild aphasia to global aphasia.

What does the middle cerebral artery mainly affect? ›

The primary function of the MCA is to supply specific regions of brain parenchyma with oxygenated blood. The cortical branches of the MCA irrigate the brain parenchyma of the primary motor and somatosensory cortical areas of the face, trunk and upper limbs, apart from the insular and auditory cortex.

What is the death rate of middle cerebral artery? ›

One of the most devastating forms of ischemic stroke, “malignant” middle cerebral artery (MCA) infarction is associated with a fatality rate of up to 80%, if untreated.

What side of the face droops when you have a stroke? ›

The lower part of one side of the face is normally affected (the forehead is usually spared). However, the eye can be involved if the stroke is in the brainstem as the person will experience damage to the facial nucleus; which will present without forehead sparing.

What artery is most common for intracranial aneurysm? ›

Cerebral aneurysms located at the posterior communicating artery and in the arteries in the back part of the brain (called the vertebral and basilar arteries) are common and have higher risk of rupture than aneurysms at other locations.

What is middle cerebral artery syndrome? ›

Middle cerebral artery syndrome is a condition whereby the blood supply from the middle cerebral artery (MCA) is restricted, leading to a reduction of the function of the portions of the brain supplied by that vessel: the lateral aspects of frontal, temporal and parietal lobes, the corona radiata, globus pallidus, ...

What is the first line diagnostic test for stroke? ›

A CT scan of the head is usually one of the first tests used for a stroke. A CT scan can show bleeding in the brain or damage to brain cells. The CT scan also can find other problems that can cause stroke symptoms.

How do doctors test for mini stroke? ›

An MRI scan is most often used. This type of scan uses a strong magnetic field and radio waves to create an image of your brain.

What is the difference between a left and right MCA stroke? ›

Left-hemispheric ischemic strokes appear to be more frequent and often have a worse outcome than their right-hemispheric counterparts. The incidence of large-vessel ischemic strokes is higher in the left middle cerebral artery distribution, contributing to these hemispheric differences.

What is the most sensitive diagnostic test for stroke? ›

Standard MRI uses computer-generated radio waves and a powerful magnet to produce detailed slices or three-dimensional images of body structures and nerves.

What is the gold standard diagnostics for stroke? ›

An MRI can detect brain tissue damaged by an ischemic stroke and brain hemorrhages. Your doctor may inject a dye into a blood vessel to view the arteries and veins and highlight blood flow (magnetic resonance angiography or magnetic resonance venography).

Can a doctor tell if you had a mini stroke in the past? ›

If you have a brain CT scan or anMRI, the image will show white spots or lesions where your brain cells have stopped functioning. That's how doctors will know you've had a silent stroke.

What causes stroke like symptoms but is not a stroke? ›

One of the most common stroke mimics is a seizure, which researchers believe account for as many as 20% of all stroke mimics. Other common stroke mimics include migraines, syncope, sepsis, brain tumor and metabolic derangement (low sodium or low blood sugar).

Can an MRI tell if you had a mini stroke? ›

Tests will be done to rule out a stroke or other disorders that may cause the symptoms: You will likely have a head CT scan or brain MRI. A stroke may show changes on these tests, but TIAs will not.

What causes a stroke in the middle cerebral artery? ›

MCA strokes are generally caused by a blood clot that travels from outside the brain. Typically, it's from the heart or carotid artery. Then the clot gets lodged in the MCA and blocks blood flow. This is called an embolic stroke.


1. Middle cerebral artery stroke | signs and symptoms.
(Xtreme Fitness By Dr. Aqsa)
2. Anterior Cerebral Artery (Mnemonic)
3. Sheelagh Meets Wayne: who had a middle cerebral artery (MCA) stroke in March 2020, aged 40.
(Different Strokes UK)
4. Anterior Cerebral Artery Stroke
(Soton Brain Hub)
5. Middle cerebral artery (MCA) Infarct (stroke) on CT brain #radiology #medicalstudent #doctor
(Dr Azku | Radiologist)
6. Ischemic Stroke - causes, symptoms, diagnosis, treatment, pathology
(Osmosis from Elsevier)


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