 Stroke is the fifth leading cause of death in the United States and the second leading cause

of death globally, accounting for nearly 12% of deaths worldwide. Although mortality has
declined in the United States, stroke remains a major source of disability.
(Ingall, T., 2004. Stroke-incidence, mortality, morbidity and risk. JOURNAL OF INSURANCE
MEDICINE-NEW YORK THEN DENVER--., 36, pp.143-152.)

 There are two main types of stroke: Ischemic and Haemorrhagic. Intracerebral hemorrhage
(ICH) encompasses 10% to 15% of all strokes. ICH occurs due to rupture of cerebral blood
vessels, often as the result of high blood pressure exerting excessive pressure on arterial
walls. Ischemic strokes or cerebral infarcts (CI) are the result of development of thrombi
and/or emboli leading to blockages and lead to hypoxia in CNS tissues. Symptoms following
both types of stroke are similar, but treatments may differ.
(Perna, R. and Temple, J., 2015. Rehabilitation outcomes: ischemic versus hemorrhagic
strokes. Behavioural Neurology, 2015.)

 Interruptions in blood supply cause hypoxia, which leads to cell death through apoptosis,
and release of inflammatory markers such as cytokines from both neurons and glia. Due to
the brain’s reliance on oxidative metabolism, hypoxic events in brain tissue can cause ATP to
drop by as much as 90% in less than 5 min. Additionally, hypoxia leads to increased
glutamate release into the synaptic cleft, leading to excitotoxicity with prolonged exposure.
(Mukandala, G., Tynan, R., Lanigan, S. and O’Connor, J.J., 2016. The effects of hypoxia and
inflammation on synaptic signaling in the CNS. Brain sciences, 6(1), p.6.)

 Ischemic strokes can present in pre-determined syndromes due to specific functional

systems in the brain correlating to patterns of damage. This allows clinicians to predict the
area of the brain vasculature that is affected through analysis of symptoms.
(Hui, C., Tadi, P. and Patti, L., 2018. Ischemic stroke.)

 The middle cerebral artery (MCA) is the most common artery involved in stroke. It supplies a
large area of the lateral surface of the brain (cortex) and part of the basal ganglia and the
internal capsule via four segments (M1, M2, M3, and M4). M1 supplies the basal ganglia,
which is involved in motor control, motor learning, executive function, and emotions. M2
(Sylvian) supplies the insula, superior temporal lobe, parietal lobe, and the inferolateral
frontal lobe.

 The MCA supplies the lateral cerebral cortex. MCA syndrome is best explained by the
understanding of the somatosensory cortex. The lateral portion contains motor and sensory
functions that involve the face and upper extremity. This correlates to the classical
presentation of contralateral hemiparesis (weakness in one side), facial paralysis, and
sensory loss in the face and upper extremity.
(Hui, C., Tadi, P. and Patti, L., 2018. Ischemic stroke.)

 “The most common cause of Broca’s aphasia is a stroke involving the dominant inferior
frontal lobe or Broca's area. A stroke in Broca's area is usually due to thrombus or emboli in
the middle cerebellar artery or internal carotid artery.” (Acharya, A.B. and Wroten, M.,
2021. Broca aphasia. StatPearls [Internet].)