Box 31 The Oxfordshire Community Stroke Project subclassification system22

Total anterior circulation syndrome (TACS); implies a large cortical stroke in middle cerebral or middle and anterior cerebral artery territories

A combination of:

— New higher cerebral dysfunction (for example dysphasia, dyscalculia, visuospatial disorder) AND

— Homonymous visual field defect AND

— An ipsilateral motor and/or sensory deficit involving at least two out of three areas of the face, arm or leg.

— Partial anterior circulation syndrome (PACS); implies cortical stroke in middle or anterior cerebral artery territory

— Patients with two out of the three components of the TACS OR new higher cerebral dysfunction alone OR a motor/sensory deficit more restricted than those classified as a LACS (for example isolated hand involvement).

Lacunar syndrome (LACS); implies a subcortical stroke due to small vessel disease

— Pure motor stroke

— Pure sensory stroke

— Sensorimotor stroke

— Ataxic hemiparesis

Note: evidence of higher cortical involvement or disturbance of consciousness excludes a lacunar syndrome.

Posterior circulation syndrome (POCS)

— Ipsilateral cranial nerve palsy with contralateral motor and/or sensory deficit

— Bilateral motor and/or sensory deficit

— Disorder of conjugate eye movement

— Cerebellar dysfunction without ipsilateral log-tract involvement

— Isolated homonymous visual field defect accuracy to guide treatment.30 The only reliable method of differentiating is early brain imaging. In many countries, this is best performed by computed tomography (CT). Lumbar puncture may be useful in confirming subarachnoid haemorrhage if the brain imaging is equivocal but it has no place in differentiating ischaemic and haemorrhagic stroke.

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