Total anterior circulation stroke

Using only a few neurological findings the Oxfordshire Community Stroke Project (OCSP) classification allocates strokes to four subgroups, locating them either in the territory of the anterior (total anterior circulation infarct, TACI partial anterior circulation infarct, PACI lacunar infarct, LACI) and the posterior circulation, (posterior circulation infarct, POCI) (Bamford et al. 1991). The OCSP is a clinical syndromic classification, which... 

Some overlap exists between the clinical classification (Bamford et al. 1991) and the etiological TOAST classification. In a large hospital-based series of patients with ischemic stroke, total and partial anterior circulation infarcts were most likely to be caused by large artery atherosclerosis, cardioembolism or both (Wardlaw et al. 1999). 

Total anterior circulation syndromes or brainstem strokes often cause some drowsiness, but in smaller lesions, consciousness is normal. Therefore if consciousness is impaired and yet the focal deficit is mild, it is important to ... 

So far predictive models only apply to a small proportion of patients and are not sufficiently accurate to inform treatment decisions in routine clinical practice. The various subtypes of ischemic stroke have very different outcomes patients with total anterior circulation infarction (TACI) have just as poor an outcome as those with primary intracerebral hemorrhage (Table 16.1). The best single predictor of early death is impaired consciousness, but many other predictors of survival have been identified (Table 16.2). Many of these variables are inter-related, but prognostic models based on independent variables do not provide much more information than an experienced clinician s estimate (Counsell and Dennis 2001 Counsell et al. 2002). 

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