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Each ischaemic stroke should be classified by arterial distribution using the history and examination.

  • Total anterior circulation infarct (TACI).
    Artery: internal carotid artery or middle cerebral artery stem
    Clinical Features:
    Higher cerebral dysfunction (e.g.: dysphasia for dominant hemisphere lesion, apraxia for non-dominant hemisphere lesion)
    PLUS homonymous visual field defect (optic radiation)
    PLUS motor (primary motor cortex)and/or sensory (somatosensory cortex) deficit involving at least two of three areas (face, arm and leg)
  • Partial anterior circulation infarct (PACI)
    Artery: internal carotid artery, middle cerebral artery stem or branch, anterior cerebral artery
    Clinical features.
    Two of the three components of the TACI syndrome
    OR higher cerebral dysfunction alone
    OR motor/sensory defi
    cit which is more restricted than a lacunar infarct (e.g. isolated hand involvement)
  • Posterior circulation infarct (POCI)
    Artery: vertebral, basilar or posterior cerebral artery
    Clinical features: Any of the following:
    ipsilateral cranial nerve palsy + contralateral motor and/or sensory deficit
    bilateral motor and/or sensory deficit
    disorder of conjugate eye movements
    cerebellar dysfunction without ipsilateral long tract signs
    isolated homonymous visual field defect or cortical blindness

    Patients with abnormal cortical function in association with any of these features should be considered to have a POCI.
    Other symptoms and signs may be present in patients with a POCI, but they are not useful in localising the lesion.

  • Lacunar infarct (LACI) (small deep infarcts)
    Artery: occlusion of a small deep perforating artery
    Clinical features: Any of the following:
    pure motor stroke
    pure sensory stroke
    ataxic hemiparesis (including dysarthria-clumsy hand syndrome, and homolateral ataxia and crural (leg) paresis
    sensorimotor stroke
In pure motor stroke and sensorimotor stroke, the deficit must involve at least two of three of the areas of the face, arm and leg and, in the arm, it should involve the whole limb and not just the hand.
Some brain stem syndromes also are caused by small vessel disease.
Any of the following exclude a diagnosis of lacunar infarct:
visual field defect
abnormal higher cerebral function (e.g.: dysphasia, apraxia)
signs of a brain stem abnormality (e.g.: gaze palsies, crossed deficits)
reduced level of consciousness (drowsiness, stupor, coma


Copyright ©Nikki Devitt 2002, on behalf of the WAHT Stroke Pathway Group

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Date of last review: 25th April 2002

Date of next review:25th October 2002