MCA Stroke – What Can Go Wrong with the Middle Cerebral Artery

by | Mar 16, 2021 | Neuro Nursing | 0 comments

You may be wondering what the difference between a regular stroke and an MCA stroke is. MCA refers to the middle cerebral artery. Sometimes people confuse it with the middle communicating artery because of the letters, but they are completely different terms.

Like other parts of the body, there are many things that could go wrong with the middle cerebral artery. The MCA is the most commonly affected cerebral artery in a stroke patient since it is the largest cerebral artery and supplies blood to many areas of the brain.

To better understand MCA strokes and the impact they have on patients, we take an inside look at some of the things that could go wrong with the middle cerebral artery.

MCA Stroke - What Can Go Wrong with the Middle Cerebral Artery

What is the Middle Cerebral Artery?

The Middle Cerebral Artery is one of the main three arteries of the brain that branches off the internal carotid artery on the inside of the neck. As an artery that supplies to the brain, it carries blood away from the heart to the outer brain surface, the basal ganglia, and both the posterior and anterior internal capsules of the brain.

A patient may be at risk of stroke if they suffer from high blood pressure which may affect the cerebral blood flow. Since cerebral artery strokes are the most common in acute stroke patients, the middle cerebral artery territory is important to study in order to better prevent cerebral infarction.

Middle Cerebral Artery Stroke

A stroke, also known as a cerebral infarction is when a blood vessel is blocked by a clot and ruptures. Since the arteries and vessels carry oxygen and other nutrients to the brain, a blockage or rupture stops blood flow and oxygen from reaching the brain. This is the reason that stroke can cause brain cells to die, among many other complications.

A middle cerebral artery stroke has to do specifically when the branches of the middle cerebral artery are affected. As the largest artery, it is made up of four branches from M1-M4. Since the middle cerebral artery supplies many different areas of the brain, acute stroke patients may present a large array of different neurological deficits and symptoms. Depending on the branch and structures affected by the stroke, different treatments and the outcome after stroke may differ vastly.

Different Types of Strokes

The three main types of stroke include ischemic stroke, hemorrhagic stroke, and transient ischemic attacks. The different types of strokes can be caused by different factors and the severity can lead to different treatment options and mortality rates.

Ischemic strokes are the most common types of strokes and the severity of the stroke can lead to different long-term outcomes. An ischemic stroke is characterized by a blockage of the artery in the brain.

People with high cholesterol can be a patient at risk of stroke because blockages in the artery can be caused by plaque buildup. This plaque buildup makes the artery more narrow and the functional outcome of cerebral blood flow is lowered until it is blocked. High blood pressure can also cause poor outcomes due to a condition called atherosclerosis or intracranial artery stenosis. This plaque is made up of low-density lipoprotein, also known as harmful cholesterol, fats, and cells. This buildup hardens and narrows the arteries and can lead to reduction or blockage of blood flow.

A patient that has these risk factors may need constant management of stroke prevention as well as blood pressure medications to prevent stroke and recurrent stroke possibilities. Sometimes ischemic strokes are not always caused by intracranial artery stenosis from cholesterol plaques. In some, acute stroke patients, ischemic strokes can also be caused by vasculitis or genetic factors that put patients at risk of stroke. They can also be caused by blot clots forming in another part of the body that travel to the brain and get lodged there.

No matter what causes the intracranial artery stenosis, ischemic strokes are characterized by blockage of arteries that carry blood, oxygen, and essential nutrients to the brain.

Hemorrhagic strokes are another type of stroke that is characterized by bleeding of the brain due to rupture of an artery. Differing from ischemic strokes which are caused by intracranial artery stenosis or occlusions, hemorrhagic strokes are caused by weakened blood vessels that burst and bleed into the other areas of the brain.

Depending on the time, affected territories, and severity of the rupture, cerebral infarction can cause different symptoms and mortality rates. There are two different types of hemorrhagic strokes which include intracerebral hemorrhaging or subarachnoid hemorrhaging. These two are different since the bleeding occurs in different territories. Intracerebral hemorrhaging occurs within the brain and subarachnoid hemorrhaging occurs outside of the brain. Bleeding into the brain causes blood to accumulate in places it should not and also compress regions of the brain tissue where the blood is accumulating.

Two common causes of a hemorrhagic stroke are the irregular formation of blood vessels which is known as arteriovenous malformations (AVM), or weakened blood vessels that cause bulging known as aneurysms. Like ischemic strokes, occlusions and intracranial stenosis could lead to stroke or be a greater risk for stroke, but hemorrhagic strokes are characterized by rupturing of the vessel.

The last main type of stroke is called a transient ischemic attack, which is also known as a mini-stroke. This does not exactly refer to the size of the stroke, but rather the length of time and the severity of the stroke. A transient ischemic attack can last anywhere from a few minutes to up to 24 hours to be considered a mini-stroke.

The blockage is temporary and usually caused by occlusions, intracranial stenosis, or a short-term blockage that goes away. Even though with this infarction, the severity is somewhat less and the mortality rates are lower, they are still extremely serious and can cause serious deficits. Even though the symptoms of transient ischemic attacks do not include death, they may still require serious rehabilitation as well as put you at risk for a serious ischemic stroke. A transient ischemic attack is usually a warning sign, and review and analysis should be taken seriously to prevent a serious ischemic infarction from occurring.  

MCA Stroke - What Can Go Wrong with the Middle Cerebral Artery

Middle Cerebral Artery Brain Aneurysm

While many confused the terms “aneurysm” and stroke, and are sometimes used interchangeably, the two terms are different and should be seen that way. While they are both serious conditions, there are notable differences between the two. 

Like mentioned before, a stroke is characterized by a blockage from intracranial stenosis or a rupture from weakened blood vessels. 

An aneurysm is the bulging or enlarging of arteries that are caused by a weakened artery wall. Sometimes aneurysms do not present any symptoms and are not life-threatening on their own. However, severe distention of the artery can cause a rupture, which can lead to serious or even fatal complications. The rupture of the aneurysm would be considered a hemorrhagic stroke, as that would mean blood is leaking outside of the blood vessels and into the tissue.

An aneurysm can occur anywhere as a result of a weak artery wall and the bursting of an aneurysm can cause different symptoms and treatments. The severity of an aneurysm depends on the size and location of the burst. A middle cerebral artery brain aneurysm is specific distention of the middle cerebral artery. MCA aneurysms are common since vessels that contain different branches are weaker and are more prone to distension. They are most common at the base of the brain since these are the territories where the artery forks into different, thinner branches. Since MCA aneurysms occur at the base of the brain and have a slightly wider area to work with, the methods for treating affected MCA aneurysms are direct surgical treatment. Although the technique seems rather straightforward, there are complications that make surgical treatment difficult and risky. 

Nursing Treatment Plans

A nursing treatment plan not only focuses on the treatment but also recognizes the needs and risks of the patient. Since the rehabilitation of an MCA stroke patient is extensive, a nursing care plan is essential to help a patient best recover from a lower level of consciousness, perceptual deficits, neurological deficits, speech deficits, and sensory deficits.

The nursing treatment plan will depend on the type of stroke as well as the areas affected. An effective treatment care plan not only helps the patient recover from their deficits, but also helps them prevent further complications as well as prevent stroke recurrence or chronic strokes even months after the first. 

Nursing Diagnosis for MCA Stroke

A nursing diagnosis refers to the process in which stroke specialists make a clinical judgment about the specific response that can develop in specific people and communities. A nursing diagnosis usually consists of three parts which include the problem and what it is, risk factors and cause, and the characteristics of the problem.

Some possible nursing diagnosis for MCA strokes specifically include:

1. Physical Mobility Deficits– This is a common problem for stroke survivors, where their physical mobility is affected, and they may need to relearn how to walk or even stand. It is usually caused by damage to the area that helps to coordinate physical movement. Stroke can also weaken the body and cause a loss of sensation. Some characteristics of physical mobility deficits include difficulty to move limbs, struggling to walk, awkward gait, or weakness of the muscles. 

2. Verbal Communication Deficits– This can also occur due to an MCA stroke if it affects the area of the brain that controls verbal communication. The problem is forgetting how to communicate or the brain and verbal communication methods not working in sync. It is usually caused by a stroke affecting the verbal area of the brain. Some characteristics of verbal communication in MCA stroke patients include difficulty understanding humor, trouble articulating, forgetting how to make sounds, and not being able to speak formed words anymore. 

3. Sensory Perception Deficits- This is also common in stroke patients depending on how quickly the stroke was treated and how long the blood supply was cut off from the brain. Sensory perception deficits may occur in stroke patients because of the lack of oxygen and blood in the brain at the time of stroke. Since our brain helps with evaluations and responses to stimuli, sensation or other sensory perceptions may be affected. Characteristics of sensory perception deficits include the inability to complete analysis on people, things, or situations. It may be hard to make comparisons or notice subtle signs. 

4. Faulty Cerebral Tissue Passage– Ineffective cerebral tissue is a common incidence in stroke patients and is characterized by the interruption of blood flow. The stroke can cause faulty cerebral tissue passage due to many factors such as high blood pressure or affected arteries. Some defining characteristics and findings of ineffective cerebral tissue passage include a different level of consciousness, memory loss, changes in sensory responses, changes in verbal or motor responses, or some patients with stroke symptoms may also have changes in vital signs. 

5. Inability to Take Care of Oneself- This often happens with severe strokes and a long period of time passing before treatment. Rehabilitation is extensive, and the patient may never be able to function on their own forever. The development of this symptom may occur due to the period of time that the stroke was not treated. Even though a person may be able to survive stroke-like symptoms for a period of time, after symptom onset, urgent treatment is imperative to regain body and brain function. Time, size and location is a major factor that determines how well a stroke patient is able to function after surgery and rehabilitation. Some defining characteristics of this include not being able to participate in everyday activities such as the inability to change, wash or go to the bathroom by yourself. A majority of stroke patients are able to relearn certain functions and activities, but with severe strokes, some may never regain certain functions. 

8. Deficient Knowledge- This refers to the problem of the inability to cope in certain situations due to a change in communication patterns. While for non-stroke patients, a problem may seem small, to those affected, one simple problem may be impossible to solve. This may occur due to the area of the brain that solves problems being affected due to the stroke. Management of these certain cognitive functions may not be as easy as some Google articles say, but constant rehabilitation and acceptance therapy may be needed for some stroke patients. Some defining characteristics include affected cognitive perception, inappropriate defense, difficulty communicating, and having trouble solving simple or more complex problems. 

7. Impaired Swallowing- This is a serious problem for many stroke survivors and for some the sensation of swallowing has become completely unfamiliar. Like other functions, there is an area of the brain that controls the ability and memory of how to swallow. For some stroke patients, they may have forgotten how to swallow which causes limitations in their eating and drinking. When trying to drink or eat, the patient may choke and forget how to swallow, which is an indication of impaired swallowing. 

8. Deficient Knowledge– This is also referred to as aphasia or memory loss on previous knowledge. This is due to the memory area of the brain being affected. In some patients, it could be the inability to make new memories and learn new information and for some is the inability to recall information or knowledge they previously knew. This may be due to damage to the area of the brain that retains knowledge or helps us remember things. Characteristics of this issue include the inability to remember simple facts, loss of memory, and the ability to make new short or long-term memories.

9. Risk for Injury– After surviving a stroke, some clinical trials show that patients are more likely to be injured. This could be in terms of a recurring stroke. If a hemorrhage occurred once, you may be at risk of it happening again. This is because some bodily functions may be impaired due to the stroke. Since the body is not functioning at full capacity, a stroke survivor may be more likely to get injured and also be more prone to recurring or chronic strokes. Some characteristics of this include patients getting easily bruised, or having stroke-like symptoms. 

What Causes an MCA Stroke?

Like causes of a normal stroke, a stroke can occur when there is an obstruction or clot where the blood flows in the brain. MCA strokes are known as embolic, which means that the clot has traveled from a different part of the body to the MCA, which blocks the blood flow in the brain. Like the risk factors for other strokes, some risk factors for MCA stroke include carotid artery disease, high cholesterol, hypertension, diabetes, and heart disease. 

MCA Stroke Symptoms

Symptoms of an MCA stroke coincide with those of a regular stroke. These include symptoms such as confusion, numbness in the limbs, unilateral numbness or weakness, facial drooping, dizziness or lack of coordination, as well as some speech impairments such as difficulty speaking. 

MCA Stroke: Final Thoughts

MCA stroke is a serious medical emergency making discussion on the topic extremely helpful to know. Learning more about the risk factors can people with management to prevent any risk of strokes or aneurysms. While WebMD can often lead us to self-diagnose, Google can be a great resource to familiarize yourself with stroke symptoms. For MCA strokes and strokes in general, immediate treatment and response can lead to the best outcomes. Hopefully, this article helped clear up any confusion regarding middle cerebral artery stroke and everything surrounding it. 

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Kati Kleber, MSN RN is a nurse educator, author, national speaker, host of the FreshRN® Podcast, and owner of FreshRN® – an online platform created to educate, encourage, and motivate newly licensed nurses in innovative ways.

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