Understanding Acute Ischemic Left MCA Stroke (Left Middle Cerebral Artery Stroke, Left MCA Infarction) is crucial for accurate clinical documentation and medical coding. This page provides information on diagnosis, symptoms, treatment, and ICD-10 codes related to Left MCA Infarction, aiding healthcare professionals in proper documentation and coding for Acute Ischemic Left MCA Stroke. Learn about the latest guidelines for managing Left Middle Cerebral Artery Stroke and improve your understanding of this serious cerebrovascular event.
Also known as
Cerebral infarction
Covers blockages in brain arteries leading to tissue death.
Cerebral infarction, middle cerebral artery
Specifically designates infarction within the middle cerebral artery.
Stroke, not specified as hemorrhage or infarction
Used when stroke type (hemorrhagic vs. ischemic) isn't confirmed.
Follow this step-by-step guide to choose the correct ICD-10 code.
Is the stroke due to infarction (blockage)?
Yes
Is the MCA affected?
No
Is it a hemorrhagic stroke?
When to use each related code
| Description |
|---|
| Sudden blockage of left MCA. |
| Blockage in right MCA. |
| Generalized decrease in brain blood flow. |
Insufficient documentation specifying the left side can lead to incorrect coding or unspecified stroke.
Missing documentation clearly establishing the acuteness of the stroke may cause coding errors affecting reimbursement.
Unclear documentation differentiating occlusion of the main MCA versus a branch may lead to inaccurate coding.
Q: What are the key early signs and symptoms suggestive of an acute ischemic left MCA stroke in a patient presenting to the emergency department?
A: Early recognition of an acute ischemic left MCA stroke is crucial for timely intervention. Clinicians should be vigilant for a combination of characteristic neurological deficits. These commonly include right-sided hemiparesis (weakness) or hemiplegia (paralysis), right-sided sensory loss, aphasia (difficulty speaking or understanding language) if the dominant hemisphere is affected, and homonymous hemianopsia (visual field loss on the same side in both eyes). Consider implementing the NIH Stroke Scale (NIHSS) immediately for rapid assessment and quantification of stroke severity. Explore how early neuroimaging with CT or MRI can help confirm the diagnosis and guide treatment decisions. Learn more about the FAST mnemonic (Facial drooping, Arm weakness, Speech difficulty, Time to call 911) for rapid identification of stroke symptoms.
Q: How does thrombolysis and thrombectomy fit into the acute management of left MCA stroke, and what are the key patient selection criteria clinicians should consider?
A: Intravenous thrombolysis with recombinant tissue plasminogen activator (rtPA, alteplase) is a cornerstone of acute ischemic stroke management, particularly for left MCA strokes, and is most effective when administered within 4.5 hours of symptom onset. Strict patient selection is essential to minimize bleeding risk. Eligibility criteria include confirmed ischemic stroke diagnosis, absence of contraindications such as recent surgery or bleeding disorders, and symptom onset within the appropriate time window. Mechanical thrombectomy, a minimally invasive procedure to remove blood clots, is also a viable treatment option for eligible patients with large vessel occlusions, including those affecting the left MCA. Patient selection for thrombectomy is based on imaging confirmation of a large vessel occlusion, time from symptom onset, and assessment of potential benefits versus risks. Explore how advanced neuroimaging techniques like CT angiography and CT perfusion can assist in identifying suitable candidates for thrombectomy.
Patient presents with acute onset of neurological deficits consistent with a left middle cerebral artery (MCA) stroke. Symptoms include right-sided hemiparesis, facial droop, and expressive aphasia. Onset of symptoms occurred approximately two hours prior to arrival. Patient denies any recent head trauma or history of seizures. Medical history significant for hypertension and hyperlipidemia. Current medications include lisinopril and atorvastatin. Neurological examination reveals decreased strength in the right upper and lower extremities, positive Babinski sign on the right, and difficulty with speech comprehension and production. NIH Stroke Scale (NIHSS) score is 12. CT scan of the head without contrast was performed and ruled out hemorrhagic stroke. Subsequent CT angiography demonstrated occlusion of the left MCA. Diagnosis of acute ischemic left MCA stroke confirmed. Treatment plan includes intravenous thrombolytic therapy with alteplase per stroke protocol guidelines. Patient to be admitted to the stroke unit for continuous neurological monitoring and supportive care. Differential diagnosis included transient ischemic attack (TIA), seizure, and migraine with aura. ICD-10 code I63.512, Cerebral infarction due to unspecified occlusion or stenosis of left middle cerebral artery, assigned. CPT codes for evaluation and management, CT head, CT angiography, and thrombolytic therapy will be documented separately. Prognosis guarded. Further evaluation and management will focus on secondary stroke prevention, rehabilitation, and speech therapy.