Total 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... 

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). 

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),... 

A 21-year-old woman with a mixed germ cell tumor of the left ovary was given intravenous chemotherapy including etoposide 100 mg/m on days 1-5, cisplatin 20 mg/m on days 1-5, and bleomycin 30 units on days 2, 8, and 15, all of which she tolerated very well (91). Three weeks later she received a second cycle, which was comphcated by an episode of dizziness on day 8. The following day she had an episode of transient dysphasia for 10 minutes. Her third course was uneventful until day 7, when she collapsed with a severe right-sided hemiparesis and dysphasia. Left-sided total anterior circulation infarction was confirmed on MRI scan. 

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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