THE causes of ischemic accidents in the territory of the middle cerebral artery (MCA) may be conveniently considered under three headings: MCA occlusion or stenosis, internal carotid artery (ICA) occlusion or stenosis, and cases in which no arterial abnormality is found.
MCA occlusions have for long been mainly ascribed by clinicians to cardiac embolism or to thrombosis. However postmortem studies have suggested that MCA thrombosis is less frequent than was formerly thought.1,2 It is well established that atherosclerotic thrombosis is by far the main etiological factor of ICA occlusions, at least in western societies. Nevertheless, particularly in younger people, there remains a rather important number of cases in which no firm etiological clue can be clinically found.3
Cases with no or slight arterial abnormality have for long been ascribed to such disorders as spasm or fall in systemic pressure. Adams and Fisher4 have, however, mentioned that
LHermitte F, Gautier JC, Derouesné C, Guiraud B. Ischemic Accidents in the Middle Cerebral Artery Territory: A Study of the Causes in 122 Cases. Arch Neurol. 1968;19(3):248–256. doi:10.1001/archneur.1968.00480030026002
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