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What is malignant MCA territory infarcts ?

Malignant MCA territory infarct can occur 
  • Due to an occlusion of the proximal MCA (M1 segment) and they are associated with an 80% mortality rate 
Occlusion at the origin of the MCA  produce 
  • Severe flaccid hemiparesis/hemiplegia
  • Contralateral homonymous heinianopia
  • Hemianesthesia
  • Conjugate gaze deviation
  • Pupillary dilatation,
  • Progressive decrease in the level of alertness 
Neurological deterioration may occur independent from raised intracranial pressure 
Global aphasia occurs if the left MCA is occluded. 
Occlusion of the right MCA produces left body neglect, and bilateral eyelid ptosis
Eyelid ptosis may be an early sign of herniation in large hemispheric infarcts and attributed to upper
brainstem involvement