Why is this a common area for blockage caused by stroke?

Question

A 57 year-old woman experienced a CVA (cerebrovascular accident or stroke). Her symptoms which include motor deficiencies in her right arm and leg, were corrected by a technique that involved catherization and removal of an embolus from the left middle cerebral artery. The medical team went right into unblocking the artery without any x-rays and MRIs. This has to be because it's a common area for blockage, but does anyone know why?

Answer 1

The middle cerebral artery (MCA) is by far the largest of the cerebral arteries and is the vessel most commonly affected by cerebrovascular accident (CVA). The stoke almost always happens on the shoulder of each branch of the artery where there is more turbulence.

for more info on MCA stroke:
http://www.emedicine.com/pmr/topic77.htm

for pics of its anatomy:
http://en.wikipedia.org/wiki/Middle_cerebral_artery

Answer 2

First of all, there is no common area for a CVA to occur. They can happen in any part of the brain. That said, they are more frequent in the anterior and middle parts of the brain because these regions are supplied blood by the Carotid Arteries. That doesn't mean that a CVA won't occur in the posterior region of the brain.....they do. But people usually don't survive these as that region controls necessary functions such as breathing.

Now, as far as the medical team unblocking the artery without any x-rays......not true. The patient should have had a Cat Scan prior to any intervention to confirm the CVA diagnosis and rule out irreversible ischemia. Dissolving clot in a person with a dead portion of brain can cause a Subarachnoid Hemmorhage and possibly death. The technique you described of removing clot in the brain is performed by an Interventional Radiologist who has done a Fellowship in Neuro-Interventional Radiology. And I can almost guarantee that he would have not done this procedure without at least a CT first.Finally, the procedure is performed in the Angiography suite at most, if not all, hospitals and requires x-rays to visualize the blood flow thru the vessels of the brain.

Now, sometimes, a large dose of TPA can be given by IV to dissolve clot in the arteries of the brain. But, once again, a CT would have been done first to confirm the CVA diagnosis.

I hope this answered your question!!!

ADDENDUM: One thing that we have all overlooked here is the possibility that the CVA could have been of the hemmoragic nature. It could have been caused by an aneurysm or, as in the case of Sen. Johnson, an AVM. Both of these conditions can mimmick symptoms of a stroke. This is why it is of great importance to scan the brain when any type of stroke, bleed, aneurysm, AVM, or any trauma is suspected.

Answer 3

Common area or not, they based it on their clinical findings. Actually you can map out the area of infarct from clinical signs alone. Variation in different people may make you wrong but we assume that the patient is not in one of the extremes.

there is a particular manifestation associated with a particular artery. Hence ......i,e, MCA - hemiparesis, aphasia (if dominant side is affected)......

In developing countries where there is deficient resources, this is how they map it out. Well the hospital in your case seemed well equiped if they can do catheterization. I supposed they must have done some sort of imaging before hand.

Answer 4

See Coldflesh's answer. And see if you can find a drawing or diagram of the Circle of Willis. A picture's worth a thousand words, and the answer will be intuitive.

Answer 5

maybe it is closer to the heart