A patient has right face, arm, and leg motor and sensory loss, right homonymous hemianopsia, left gaze preference, global aphasia, acalculia. Which stroke territory is most likely?

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This pattern points to a large stroke in the dominant left MCA territory, involving both the frontal and parietal lobes. Global aphasia indicates disruption of language areas on the dominant side (Broca’s and Wernicke’s areas), which requires more extensive MCA involvement than the superior or inferior division alone. Acalcula implies involvement of the dominant angular gyrus in the inferior parietal lobule, another MCA region. Right face–arm–leg motor and sensory loss shows the corticospinal and sensory pathways in the left hemisphere are affected. Right homonymous hemianopsia comes from involvement of the left optic radiations, which are supplied by the MCA territory as it courses through the temporal–parietal regions. Left frontal eye fields, when damaged, produce a gaze preference toward the side of the lesion, so a left gaze preference fits a left hemisphere process. Putting all these signs together fits a left MCA stem (trunk) stroke, which encompasses both superior and inferior divisions and explains the broad language, parietal, motor, sensory, and visual field deficits. Left PCA or isolated left MCA inferior would not account for the full combination, and a right MCA lesion would not produce dominant-language deficits like global aphasia.