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    Classification of Stroke

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    afhamazman
    The document defines stroke according to the WHO as a focal or global disturbance of cerebral function lasting over 24 hours caused by a vascular event. It classifies strokes as ischemic, hemorrhagic, or transient ischemic attack. The OCSP classification further divides ischemic strokes into total anterior circulation infarct, partial anterior circulation infarct, lacunar infarct, or posterior circulation infarct based on symptoms. The TOAST classification categorizes ischemic strokes as large artery atherosclerosis, small vessel occlusion, cardioembolism, other determined etiology, or undetermined etiology based on clinical features and imaging results.

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    Classification of Stroke

    Uploaded by

    afhamazman
    90 views3 pages
    The document defines stroke according to the WHO as a focal or global disturbance of cerebral function lasting over 24 hours caused by a vascular event. It classifies strokes as ischemic, hemorrhagic, or transient ischemic attack. The OCSP classification further divides ischemic strokes into total anterior circulation infarct, partial anterior circulation infarct, lacunar infarct, or posterior circulation infarct based on symptoms. The TOAST classification categorizes ischemic strokes as large artery atherosclerosis, small vessel occlusion, cardioembolism, other determined etiology, or undetermined etiology based on clinical features and imaging results.

    Original Description:

    How do we classify stroke? What are the characteristic difference of the stroke types.

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    The document defines stroke according to the WHO as a focal or global disturbance of cerebral function lasting over 24 hours caused by a vascular event. It classifies strokes as ischemic, hemorrhagic, or transient ischemic attack. The OCSP classification further divides ischemic strokes into total anterior circulation infarct, partial anterior circulation infarct, lacunar infarct, or posterior circulation infarct based on symptoms. The TOAST classification categorizes ischemic strokes as large artery atherosclerosis, small vessel occlusion, cardioembolism, other determined etiology, or undetermined etiology based on clinical features and imaging results.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    90 views3 pages

    Classification of Stroke

    Uploaded by

    afhamazman
    The document defines stroke according to the WHO as a focal or global disturbance of cerebral function lasting over 24 hours caused by a vascular event. It classifies strokes as ischemic, hemorrhagic, or transient ischemic attack. The OCSP classification further divides ischemic strokes into total anterior circulation infarct, partial anterior circulation infarct, lacunar infarct, or posterior circulation infarct based on symptoms. The TOAST classification categorizes ischemic strokes as large artery atherosclerosis, small vessel occlusion, cardioembolism, other determined etiology, or undetermined etiology based on clinical features and imaging results.

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    © All Rights Reserved
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    of 3

    A.

    WHO DEFINITION AND CLASSIFICATION OF STROKE

    Definition : Rapidly developing clinical signs of focal ( or global ) disturbance of


    cerebral function , with symptoms lasting 24 hours or longer or leading to death ,
    with no apparent cause other than of vascular origin . (1983)

    WHO Classification ( clinical assessment and imaging ) :

     Ischaemic Stroke
     Intracranial Haemorrhage
     Subarachnoid Haemorrhage
     Transient Ischaemic Attack

    B. OCSP (Oxford Community Stroke Project) CLASSIFICATION :

    Acute Ischaemic Stroke Classification :

    1. Total Anterior Circulation Infarct ( TACI ) :

    At time of maximum deficit , all of :

     Hemiplegia or severe hemiparesis contralateral to the cerebral


    lesion
     Hemianopia contralateral to the cerebral lesion
     New disturbance of higher cerebral function ( e.g. aphasia,
    visuospatial disturbance )

    2. Partial Anterior Circulation Infarct ( PACI ) :

    At time of maximum deficit , any of :

     Motor / sensory deficit + hemianopia


     Motor / sensory deficit + new higher cerebral dysfunction
     New higher cerebral + hemianopia
     Pure motor / sensory deficit less extensive than Lacunar
    Syndromes ( e.g. monoparesis )
     New higher cerebral dysfunction alone ( e.g. aphasia )

    When more than one type of deficit is present, they must all reflect
    damage in the same cerebral hemisphere .
    3. Lacunar Infarct ( LACI ) :

     Maximum deficit from a single vascular event


     No visual field deficit
     No new disturbances of higher function
     No signs of brain stem disturbance

    Categories of LACI :

    a. Pure motor stroke ( PMS )


    b. Pure sensory stroke ( PSS )
    c. Ataxic hemiparesis ( including dysarthria , clumsy-hand syndrome
    and homolateral ataxia and crural paresis ) ( AH )
    d. Sensorimotor stroke ( SMS )

    4. Posterior Circulation Infarct ( POCI )

    At time of maximum deficit , any of :

     Ipsilateral cranial nerve ( III – XII ) palsy ( single or multiple ) with


    contralateral motor and / or sensory deficit
     Bilateral motor and / or sensory deficit
     Disorder of conjugate eye movement ( vertical or horizontal )
     Cerebellar dysfunction without ipsilateral long tract deficit ( as seen
    in ataxic hemiparesis )
     Isolated hemianopia or cortical blindness

    5. Unclassified
    C. TOAST CLASSIFICATION :

    Acute Ischaemic Stroke :

     Large artery occlusion


     Small vessel occlusion
     Cardioembolism
     Determined aetiology
     Undetermined aetiology

    Features Large-artery Cardioembolism Small-artery Other cause


    atherosclerosis occlusion
    (lacune)

    Clinical

    Cortical or
    cerebellar + + - +/-
    dysfunction

    Lacunar syndrome - - + +/-

    Imaging

    Cortical, cerebellar,
    brainstem & + + - +/-
    subcortical
    infarct > 1.5 cm

    Subcortical or
    brainstem infarct - - +/- +/-
    < 1.5 cm

    Test

    Stenosis of
    extracranial + - - -
    internal carotid
    artery

    Cardiac source of - + - -
    emboli
    - - - +
    Other abnormality
    on test

    Dr Khairul Azmi HSNZ

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