Summary table
| Stroke Type | Infarct(I) Haemorrhage (H) Stroke (S) | Weakness /sensory loss face, arm and leg | Homonymous Hemianopia (HH) | Higher centres | Vertigo, dysphagia, diplopia, cerebellar signs | Notes | Vascular Supply | Frequency | Fatality at 6 months | Dead/Dependent (Rankin 3-6) at 6 months |
|---|---|---|---|---|---|---|---|---|---|---|
| Total anterior circulation | TAC/S/H/I | Must have weakness/sensory loss | Must Have hemianopia | Must have Dysphasia or Neglect | No | Needs all 3. | Large cortical stroke in MCA/ACA areas. | 20% | 56% | 96% |
| Partial anterior circulation | PAC/S/H/I | May have weakness/sensory loss | May Have hemianopia | Must have Dysphasia or Neglect | No | Needs 2 out of 3. | Smaller cortical stroke in MCA/ACA areas | 35% | 10% | 45% |
| Lacunar stroke | LAC/S/H/I | Must have either pure motor/pure sensory/ataxic hemiparesis | No | No | May have if pontine lacunar | Subcortical/pontine stroke Lenticulostriate or pontine perforators | 25% | 7% | 34% | |
| Posterior circulation | POC/S/H/I | May have weakness/sensory loss | May Have hemianopia | No dysphasia/Neglect | Yes | Cerebellar or brainstem syndromes, coma, isolated homonymous hemianopia | Vertebral/Basilar or PCA | 25% | 14% | 32% |
Questions
1. Mary has a right sided face/arm weakness and cannot see to her right. She has dysphasia. What is this classified as ?
She has weakness + Homonymous hemianopia + Dysphasia = Left Total anterior circulation stroke (TACS)
2. John feels that the room is spinning and has double vision but no weakness but he has some cerebellar signs. What is this classified as ?
He has Vertigo and diplopia and cerebellar signs so this is a Posterior circulation stroke (POCS)
3. Mildred is right handed and has dysphasia and no other deficit . What is this classified as
She has dysphasia and no weakness or hemianopa which makes this a Left Partial anterior circulation stroke (TACS)
4. Bertha has a clumsy weak left hand and all else is fine What is this classified as ?
Clumsy hand but no cortical signs or hemianopia so this is a Right Lacunar stroke (LACS)
5. Ajay has a left homonymous hemianopia but no motor or sensory signs
Isolated HH is usually a Right Posterior circulation stroke most likely (R PCA)
6. Which is the worst stroke to have here in terms of OCSP classification ?
Left Total anterior circulation stroke (TACS) of which 56% have mortality at 6 months
7. Which strokes have best outcome in terms of OCSP classification ?
LACS/POCS : LACs have 7% mortality at 6 months and POCS have 14% mortality at 6 months
8. Sunil has an isolated left weak arm and hand but speech and sensory and vision and language all normal. What is this classified as ?
R LACS
9. Rita has left arm and leg weakness and ignores her left side and appears to have neglect on that side. She also has a left Homonymous hemianopia. What is this classified as ?
R Total anterior circulation stroke (TACS)
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