Makindo Medical Notes.com

Related Subjects: |Acute Stroke Assessment (ROSIER&NIHSS) |Atrial Fibrillation |Atrial Myxoma |Causes of Stroke |Ischaemic Stroke |Cancer and Stroke |Cardioembolic stroke |CT Basics for Stroke |Endocarditis and Stroke |Haemorrhagic Stroke |Stroke Thrombolysis |Hyperacute Stroke Care |Hypertension

Oxford community stroke project - provides a useful classification which can help determine prognosis

Terminology

• TAC:Total Anterior Circulation Stroke
• LAC: Lacunar Stroke
• PAC: Partial Anterior Circulation Stroke
• POC: Posterior Circulation Stroke

Code last letter as follows:

• (S): Syndrome: Indeterminate pathogenesis, prior to imaging (e.g., TACS)
• (I): Infarct (e.g., TACI)
• (H): Haemorrhage (e.g., TACH)

Total anterior circulation stroke (TACS) - Clinically all 3 of these are present

• Higher dysfunction e.g. dysphasia (left hemisphere, visuospatial and neglect (left hemisphere)
• Homonymous hemianopia
• Weakness/sensory loss in at least 2/3 of face, arm, leg.
• 40% Mortality within 30 days

Partial anterior circulation stroke (PACS) 

Clinically all 2 of these are present
• Higher dysfunction e.g. dysphasia (left hemisphere, visuospatial and neglect (left hemisphere)
• Homonymous hemianopia
• Weakness/sensory loss in at least 2/3 of face, arm, leg
• 10% mortality within 30 days in small cortical infarcts

Lacunar stroke (LACS)

• Occlusion of small perforating arteries which branch of the MCA at right angles to supply the internal capsule and other deep structures
• Clinically differentiated from PACS by the absence of cortical features e.g. apraxia, dysphasia etc Less than 3% death within 30 days
• Hypertension - small vessels affected. In situ thrombosis, embolism unlikely
• Lacunar syndromes e.g. Pure motor (damage to the posterior limb of internal capsule), Pure sensory (thalamus), Sensorimotor (thalamus and posterior limb of internal capsule), Ataxic (variable), Dysarthria and Clumsy hand (pons)
• Small lacunae < 15 mm in size. Seen in the corona radiata, basal ganglia, internal capsule, thalamus, pons

Posterior circulation stroke (POCS)

• More subtle in its milder forms but overall reasonably good prognosis
• Watch out for the rare but often quoted "top of the basilar" syndrome
• May be due to small vessel disease or embolism via the vertebral arteries
• Vertebrals and their branches supply the Brainstem, occipital lobes, thalami
• Dizziness, Vertigo, Diplopia, Nausea, Vomiting, Nystagmus
• Cerebellar signs, Altered consciousness, Horner's syndrome, Bulbar signs - impaired swallow, Chorea, hemiballismus