Makindo Medical Notes

Related Subjects: |Acute Stroke Assessment (ROSIER&NIHSS) |Atrial Fibrillation |Atrial Myxoma |Causes of Stroke |Ischaemic Stroke |Cancer and Stroke |Cardioembolic stroke |CT Basics for Stroke |Endocarditis and Stroke |Haemorrhagic Stroke |Stroke Thrombolysis |Hyperacute Stroke Care |Hypertension

Introduction

• 🧠 The Oxford Community Stroke Project classification (Bamford classification) is widely used to categorise stroke subtypes based on clinical features.
• It provides both prognostic and anatomical/etiological insights, useful at the bedside before imaging.
• Four main subtypes:
  • 🎯 Lacunar Infarcts (LACI)
  • 🌐 Total Anterior Circulation Infarcts (TACI)
  • 🔻 Partial Anterior Circulation Infarcts (PACI)
  • 🌀 Posterior Circulation Infarcts (POCI)
• Although first applied to infarcts, the classification can also describe haemorrhagic strokes once imaging clarifies pathology.

Anterior vs Posterior Circulation

• ➡️ Anterior circulation: internal carotid arteries → ACA & MCA territories (frontal, parietal, lateral temporal lobes).
• ⬅️ Posterior circulation: vertebrobasilar system → brainstem, cerebellum, occipital lobes, thalamus.
• This division underpins the Bamford classification: anterior strokes exclude vertebrobasilar involvement; posterior strokes exclude carotid territory.

📝 Clinical pearl: The Bamford system is based on bedside findings — powerful for rapid classification before CT/MRI.

Classification

• 🎯 Lacunar Infarcts (LACI):
  • Pure motor stroke
  • Pure sensory stroke
  • Sensorimotor stroke
  • Ataxic hemiparesis
  • Note: ❌ No higher cortical dysfunction (no aphasia, neglect).
• 🌐 Total Anterior Circulation Infarcts (TACI): Must have all 3:
  • Higher cerebral dysfunction (e.g., dysphasia, neglect)
  • Homonymous hemianopia
  • Ipsilateral motor/sensory deficit in ≥2 areas (face, arm, leg)
• 🔻 Partial Anterior Circulation Infarcts (PACI):
  • Two of the TACI features, OR
  • Higher cerebral dysfunction alone, OR
  • More restricted motor/sensory deficit than LACI
• 🌀 Posterior Circulation Infarcts (POCI): Any of:
  • Ipsilateral cranial nerve palsy + contralateral motor/sensory deficit
  • Bilateral motor/sensory deficit
  • Disorders of conjugate eye movement
  • Cerebellar dysfunction
  • Isolated homonymous hemianopia

Summary Table

Assessment

Quick bedside check for Bamford classification = look for 4 features:

• 💪 Hemiparesis or hemisensory loss (face, arm, leg)
• 🗣️ Higher cortical dysfunction (language/neglect)
• 👁️ Homonymous hemianopia
• 🧭 Brainstem/cerebellar signs (vertigo, diplopia, dysphagia, ataxia)

📊 Coding convention: I = Infarct (TACI → TAI) H = Haemorrhage (TACH) S = Syndrome (clinical diagnosis before imaging, e.g. TACS)

References

• Bamford et al. Oxfordshire Community Stroke Project, JNNP 1988