Partial anterior circulation

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... 

Subcortical white matter infarcts may mimic a superficial MCA infarct causing a partial anterior circulation syndrome or present as a lacunar syndrome (pure motor, ataxic hemiparesis or sensori motor stroke). Superficial perforating artery infarcts (medullary branches) are often accompanied by cortical spotty lesions. Borderzone and white matter medullary branches infarctions are usually caused by hypoperfusion due lo large vessel occlusion or stenosis (Bogousslavsky 1993 Donnan and Yasaka 1998), but white matter medullary branches infarction can also be caused by cardioembolism (Lee et al. 2003). 

Mrs SL, aged 75, is admitted to hospital unable to speak, swallow or move her right arm and leg, having collapsed when out to dinner with her son. She has an urgent CT scan which reveals an ischaemic stroke of the partial anterior circulation (PAC) type. She had a transient ischaemic attack (TIA) two weeks ago and her son says she has had them infrequently for the last year. She has been treated for hypertension and high cholesterol for the past 2 years and has been taking aspirin. 

It may be difficult to distinguish between some partial anterior circulation syndromes and a lacunar stroke. 

Partial anterior circulation infarcts (Fig. 9.4) are caused by occlusion of a branch of the middle cerebral artery, or rarely the trunk of the anterior cerebral artery. They are usually... 

Some anterior circulation syndromes, usually classified as partial anterior circulation syndromes, are caused by boundary zone infarcts. The rare anterior choroidal artery distribution infarcts, which can be defined only by the CT or MRI pattern, are probably caused by microvascular disease as well as embolism, and they can lead to a partial anterior circulation syndrome or lacunar syndrome (Hupperts et al. 1994). 

Lacunar syndromes are defined clinically. They are highly predictive of small, deep lesions affecting the motor and/or sensory pathways in the corona radiata, internal capsule, thalamus, cerebral peduncle or pons. Although a few patients have a partial anterior circulation infarct (Bamford et al. 1987 Anzalone and Landi 1989 Arboix et al. 2007), the great majority have small iirfarcts, which are sometimes visible on CT, more often on MRI. These are caused by presumed occlusion of a small perforating artery affected by intracranial small vessel disease (see Fig. 10.2). There is no visual field defect, no new cortical... 

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). 

LACI, lacunar infarct TACI, total anterior circulation infarct PACI, partial anterior circulation infara POCI, posterior circulation infarct Dep, functionally dependent (Rankin 3-5) Indep, functionally independent (Rankin 0-2). Source From Bamford et al. (1991),... 

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