![]() This is termed a homonymous hemianopia-homonymous because the pattern of deficit is the same for each eye, and hemianopia because the deficit is half the visual field. The nerve fibres leading from the optic nerve of the eye to the ‘computer chip’ for vision travel though the deep areas of the middle cerebral artery territory, and thus the field of vision on the opposite side of the body is lost. In addition, the ‘computer chip’ of the parts of the brain controlling sensation may be affected, leading to lack of sensation on the opposite side of the body. A TACI stroke will include the cortical areas, the ‘computer chip’ parts of the brain controlling motor power, and thus will lead to paralysis of the face, arm, and leg of the opposite side of the body, termed a hemiparesis or hemiplegia. ![]() The good news is that immediate thrombolysis and thrombectomy, a new intervention for stroke, can lead to substantial improvements in this type of stroke. The consequences of such a stroke are major, if left untreated. Over the minutes and hours following a middle cerebral artery occlusion, the brain dies from the central core outwards, leaving a very large deficit if untreated. There may be small interconnections with other blood vessels over the surface of the brain and at the periphery of the middle cerebral artery territory, but these ‘collateral’ blood vessels are rarely adequate to ensure survival of this part of the brain. ![]() Unfortunately, the blood supply to this part of the brain is nearly all through this one main blood vessel. A stroke causing such an occlusion leads to a large volume of brain becoming ischaemic, and in time this affected area will die. A TACI stroke is a large stroke due to occlusion of a large blood vessel of the brain, usually the main stem of the middle cerebral artery, but a similar deficit may occur when the blockage occurs in the internal carotid artery (Figure 4.1). ![]()
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