Partial 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... 

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. 

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). 

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