Left Middle Cerebral Artery (MCA) or Left Internal Carotid Artery (ICA) Stroke Syndrome

Clinical Localization

The American Heart Association suggests that right-sided weakness with right facial drooping indicates ischemia or infarction in the distribution of the left internal carotid artery or left middle cerebral artery, typically localizing to the left hemisphere, specifically the left MCA territory, which is the most common location for this presentation 1
The left ICA territory can produce identical symptoms to the left MCA territory, including right-sided body weakness and right facial involvement, which are supplied by the MCA territory 1

The American Heart Association recommends assessing for aphasia (language dysfunction) as a critical distinguishing feature of left hemisphere stroke in right-handed individuals, as well as right-sided sensory loss or paresthesias, and left visual field deficits (left homonymous hemianopsia) or monocular blindness affecting the left eye 1

The American College of Radiology suggests that brain MRI with diffusion-weighted imaging (DWI) is the preferred initial test for urgent neuroimaging, and if MRI is unavailable, a non-contrast CT head should be performed to exclude hemorrhage 3, 4
The American Heart Association recommends completing CT angiography (CTA) or MR angiography (MRA) from aortic arch to vertex within 24 hours to identify large vessel occlusion requiring thrombectomy 2, 4

The American Heart Association suggests evaluating for intravenous thrombolysis (tPA) if presenting within 4.5 hours, and assessing for endovascular thrombectomy if large vessel occlusion is confirmed on CTA 5, 4
Patients with large MCA infarctions (especially under age 60) may require decompressive hemicraniectomy for malignant cerebral edema, according to the American Academy of Neurology 2