AN62.1-6 | Cranial nerve nuclei & Cerebral hemispheres — Part 3

CLINICAL PEARL

MCA Stroke — Most Common Stroke in India

Left MCA territory (dominant hemisphere) infarct causes the classic triad:
1. Right hemiplegia (arm > leg, face included — lateral motor cortex + internal capsule)
2. Broca's (expressive) aphasia or Wernicke's (receptive) aphasia depending on sub-territory
3. Right homonymous hemianopia (optic radiation involvement)

CT brain in acute MCA stroke:
• Early signs (<6h): hyperdense MCA sign (clot in vessel), loss of grey-white differentiation, sulcal effacement
• 24–72h: low-density wedge-shaped infarct in MCA territory

Indian thrombolysis reality: IV tPA (alteplase) within 4.5 hours is standard of care; mechanical thrombectomy (clot retrieval) within 24 hours for large vessel occlusion. Only 2–3% of Indian stroke patients reach hospital in time for thrombolysis — a major healthcare access challenge.