The formation of an area of coagulation necrosis in the vascular distribution of the middle cerebral artery secondary to ISCHEMIA. Clinical features include contralateral weakness and loss of sensation in the arm and face and a contralateral homonymous hemianopsia. Dominant hemisphere lesions may produce APHASIA, alexia, AGRAPHIA, acalculia, finger agnosia, and right-left confusion. Nondominant hemisphere lesions may produce unilateral neglect, dressing APRAXIA, anosognosia, and constructional apraxia. (From Adams et al., Principles of Neurology, 6th ed, p786).