Territory of middle cerebral artery (cortical branches of MCA)

The middle cerebral artery (MCA) has cortical branches and deep penetrating branches (lateral lenticulo-striate arteries).

The cortical branches of the MCA supply the lateral surface of the hemisphere, except for the medial part of the frontal and the parietal lobe (anterior cerebral artery), and the inferior part of the temporal lobe (posterior cerebral artery).

Stroke pattern: 

• Superficial middle cerebral artery infarct:
  • Left hemisphere (dominant for language): oral and written language distrubances dominate
  • Right hemisphere (non dominant): strokes neglect
• Superficial anterior or superior division infarcts: contralateral hemiparesis with predominant brachiofacial deficit, hemisensory loss, gaze deviation towards the lesion. If left sided infarct, non-fluent aphasia from mutism to Broca’s aphasia and bucco-facial apraxia. If right sided, strokes neglect with anosognosia. 
• Superficial posterior or inferior division infarcts: hemisensory loss, visual field defects (homonymous hemianopia or upper quadrantanopia), fluent aphasia of Wernicke’s aphasia with anosognosia and behavioural disturbances if left-sided stroke and neglect, anosognosia and agitated confusional stale if right-sided stroke. 
• Large infarcts (deep and superficial): severe neurological deficit with gaze deviation, contralateral hemiplegia, global aphasia or neglect with anosognosia, hemianopia and reduced consciousness.