Stroke- Ischemic stroke classification

Key facts

• The Oxford Community Stroke Project classification of sub-types of cerebral infarction aka Bamford classification aka Oxford classification
• Based on bedside clinical signs and symptoms
• Helpful to appreciate aetiology and prognosis

Assessment of a suspected stroke patient

When examining a patient with suspected stroke, look for these signs which will help to classify patients into Bamford classification

• Hemiparesis or Hemisensory loss in the Face/Arm/Leg
• Higher cortical dysfunction (including language problems)
• Homonymous hemianopia
• Brainstem signs: Vertigo, dysphagia, diplopia, cerebellar signs

Nomenclature

Originally developed for ischaemic stroke but can be used in haemorrhagic stroke post-CT scan. I= Ischaemic (e.g. PACI) S= denoted prior to CT to represent syndrome (PACS) H= Haemorrhagic (PACH)

Total Anterior Circulation Infarct (TACI)

• Frequency 20%; Mortality at 6 months 56%
• Must have all 3 symptoms below
  • Ipsilateral motor and/or sensory deficit of at least two areas (of face, arm and leg).
  • Higher cerebral dysfunction (e.g. dysphasia)
  • Homonymous visual field defect
• Arteries involved
  • MCA and ACA

Partial Anterior Circulation Infarct (PACI)

• Frequency 35%, Mortality at 6 months 10%
• Must have 2 out of 3 symptoms below OR can present with dysphasia or neglect alone
  • Unilateral motor and/or sensory deficit of at least two areas (of face, arm and leg)
  • Homonymous visual field defect
  • Higher cerebral dysfunction (e.g. dysphasia)
• arteries involved: small cortical arteries of the MCA and ACA

Posterior circulation Infarct (POCI)

• Frequency 25%, Mortality at 6 months 14%
• any of
  • Ipsilateral cranial nerve palsy with contralateral motor and/or sensory deficit
  • Bilateral motor and/or sensory deficit
  • Disorder of conjugate eye movement
  • Cerebellar dysfunction
  • Isolated homonymous visual field defect
• Arteries involved: vertebrobasillar artery

Lacunar infarct (LACI)

• Frequency 25%, Mortality at 6 months 7%
• Any of
  • Pure motor stroke
  • Pure sensory stroke
  • Sensory motor stroke
  • Ataxic haemiparesis
• Arteries involved: lenticulostriate or pontine perforators