Makindo Medical Notes Comprehensive Medical Encyclopedia | Education for Healthcare Professionals

Makindo Medical Notes "One small step for man, one large step for Makindo"
Download all this content in the Apps now Android App and Apple iPhone/Pad App

MEDICAL DISCLAIMER: The contents are under continuing development and improvements and despite all efforts may contain errors of omission or fact. This is not to be used for the assessment, diagnosis, or management of patients. It should not be regarded as medical advice by healthcare workers or laypeople. It is for educational purposes only. Please adhere to your local protocols. Use the BNF for drug information. If you are unwell please seek urgent healthcare advice. If you do not accept this then please do not use the website. Makindo Ltd.

Oxford community stroke project (Bamford)

About

Anaesthetics and Critical Care

Obstetrics Gynaecology

Oncology

Ophthalmology

Oral Medicine and Dentistry

Statistics and Research

Stroke

Surgery

Toxicology

Trauma and Orthopaedics

Twitter

Urology

🧠 The Oxford Community Stroke Project (OCSP) classification is widely used in UK practice to predict stroke prognosis from clinical features alone, before imaging. It divides strokes into four main categories.

📖 Terminology

TACS: Total Anterior Circulation Stroke
PACS: Partial Anterior Circulation Stroke
LACS: Lacunar Stroke
POCS: Posterior Circulation Stroke

Category	Stands for	Key Clinical Features	Typical Vascular Territory
TACS	Total Anterior Circulation Stroke	All three of: • Higher cortical dysfunction (e.g. dysphasia, neglect) • Homonymous visual field defect • Contralateral motor and/or sensory deficit of ≥2 regions (face/arm/leg)	Large MCA territory often including ACA/MCA border-zone; proximal ICA/MCA occlusion.
PACS	Partial Anterior Circulation Stroke	Any one of: • Higher cortical dysfunction alone • Two of the three TACS components • Pure motor/sensory deficit more restricted than TACS	Branch occlusions in MCA or ACA territory; smaller cortical or subcortical infarcts in anterior circulation.
LACS	Lacunar Stroke	Pure lacunar syndromes with no cortical signs: • Pure motor • Pure sensory • Sensorimotor • Ataxic hemiparesis / dysarthria–clumsy hand	Small deep perforating artery infarcts in internal capsule, thalamus, basal ganglia, pons, etc.
POCS	Posterior Circulation Stroke	One or more of: • Brainstem signs (e.g. diplopia, dysarthria, dysphagia, vertigo) • Cerebellar signs (e.g. ataxia) • Isolated homonymous visual loss	Vertebrobasilar system – brainstem, cerebellum, occipital lobes, thalami.

🧾 Classification Suffixes

(S): Syndrome – based on clinical diagnosis before imaging (e.g. TACS)
(I): Infarct – confirmed by imaging (e.g. TACI)
(H): Haemorrhage – confirmed bleed (e.g. TACH)

🌐 Total Anterior Circulation Stroke (TACS)

⚠️ All three of the following must be present:

Higher cortical dysfunction: Dysphasia (usually left hemisphere) or visuospatial neglect (usually right)
Homonymous hemianopia: Visual field loss on the same side in both eyes
Motor/sensory deficit: Face + arm + leg involvement (at least two regions)
Prognosis: 💀 ~40% 30-day mortality; survivors often have severe disability

🌍 Partial Anterior Circulation Stroke (PACS)

✅ Any two of the three TACS features or isolated higher cortical dysfunction:

Dysphasia or visuospatial neglect
Partial homonymous hemianopia
Weakness/sensory loss in face, arm, or leg (not all three)
Prognosis: ⚖️ ~10% 30-day mortality; usually small cortical infarcts

🔬 Lacunar Stroke (LACS)

Pathology: Occlusion of small perforators (internal capsule, thalamus, basal ganglia, pons)
Features: ❌ No cortical signs (no aphasia, neglect, or apraxia)
Syndromes:
- Pure motor hemiparesis
- Pure sensory stroke
- Sensorimotor stroke
- Ataxic hemiparesis
- Dysarthria–clumsy hand
Prognosis: 🙂 <3% 30-day mortality; often good recovery

🌀 Posterior Circulation Stroke (POCS)

Symptoms: Dizziness, vertigo, diplopia, nausea/vomiting, nystagmus, cerebellar signs, Horner’s syndrome
Structures: Brainstem, occipital lobes, thalami (vertebral + basilar supply)
Key Syndromes: “Top of the basilar” – bilateral infarcts with coma, visual and cranial nerve involvement
Signs: Cerebellar ataxia, dysphagia, visual field defects, movement disorders (hemiballismus, chorea)
Prognosis: Variable – many do well, but brainstem involvement can be devastating

🩺 Management Considerations

TACS: Urgent stabilization, thrombolysis/thrombectomy if eligible; monitor for oedema + herniation
PACS: Thrombolysis if eligible; secondary prevention + rehab for language/neglect deficits
LACS: Antiplatelets + vascular risk factor control (esp. hypertension); usually good rehab potential
POCS: Careful imaging and neuro assessment; thrombolysis/thrombectomy possible; manage brainstem/cerebellar complications (e.g. hydrocephalus)

📊 Prognosis Summary

🔴 TACS: Poor prognosis (40% mortality at 30 days)
🟠 PACS: Moderate (10% mortality)
🟢 LACS: Favourable (<3% mortality, good recovery)
🔵 POCS: Variable – depends on extent (mild cerebellar vs severe brainstem stroke)

📚 References

💡 Exam Pearl: If you see all three features (cortical dysfunction + hemianopia + motor/sensory deficit), always call it a TACS until proven otherwise. Prognosis is much worse than PACS or LACS.

PLEASE NOTE LEGAL ADVICE: The contents are under continuing development and improvements and may contain errors of omission or fact. Feedback vital and always welcome at drokane at gmail.com. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice. It is only for educational purposes. Please adhere to your local protocols. If you are unwell please seek healthcare advice from your doctor. This does not replace senior or specialist advice. If you do not accept this then please do not use the website. If you need medical advice, please consult a doctor or other appropriate medical professional. If you are a medical professional and you need advice then speak to your senior or colleagues.

Edit