Stroke By Anatomy And Circulation – At A Glance

According to WHO, a Stroke is defined as “rapidly developed clinical signs of focal (or global) disturbance of cerebral function, lasting more than 24 hours or leading to death, with no apparent cause other than of vascular origin”

Simply in other words, its a medical condition that occurs due to death of brain cells 

Stroke is broadly classified into….

  • Ischemic stroke 
  • Haemorrhagic stroke 

  

Classification Of Stroke – According To The Blood Supply

  • Total anterior circulatory stroke (TACS)
    • Supplied by anterior and middle cerebral arteries 
      • Higher cerebral dysfunction 
      • Contralateral sensory/motor deficit – Face, arm, leg
      • Homonymous hemianopia
         
  • Partial anterior circulatory stroke (PACS)
    • 2 out of 3 criteria should be present
      • Higher cerebral dysfunction
      • Contralateral sensory/motor deficit – Face, arm, leg
      • Homonymous hemianopia
         
  • Posterior circulation syndrome (POCS)
    • Supplied by posterior cerebral artery 
    • 1 out of the following criteria should be present 
      • Bilateral motor/sensor deficit
      • Crossed cranial nerve involvement with motor/sensory deficit 
      • Cerebellar dysfunction 
      • Conjugate eye movement disorder (Gaze palsy) 
      • Isolated homonymous hemianopia
         
  • Lacunar stroke (LACS)
    • Subcortical stroke involving small vessels
    • No loss of higher cerebral functions
    • 1 out of the following criteria should be present 
      • Pure motor syndrome
      • Pure sensory syndrome
      • Ataxic hemiparesis 
      • Clummy hand syndrome



Classification Of Stroke – According To Anatomical Site

  • Anterior cerebral arteries 
    • Contralateral hemiparesis with sensory loss 
    • Lower limbs are more involved than the upper limbs
       
  • Middle cerebral arteries 
    • Contralateral hemiparesis with sensory loss 
    • Upper limbs are more involved than the lower limbs 
    • Contralateral homonymous hemianopia 
    • Wernicke’s aphasia
    • Gaze abnormalities
       
  • Posterior cerebral arteries 
  • Lacunar
    • Involves basal ganglia, thalamus or internal capsule
      • Pure motor syndrome – Isolated hemiparesis
      • Pure sensory syndrome – Isolated hemisensory loss
      • Ataxic hemiparesis
         
  • Lateral medulla (Lateral medullary syndrome / Wallenberg syndrome)
    • Involves the posterior inferior cerebellar artery (PICA)
      • Ipsilateral facial sensory loss
      • Crossed hemisensory loss of the trunk
      • Cerebellar dysfunction 
      • Dysphagia 
      • Horner’s syndrome
         
  • Pons
    • Horizontal gaze palsy – VI nerve involvement
    • Facial palsy – VII nerve involvement 
    • Contralateral hemiparesis
       
  • Basilar artery
    • Locked-in syndrome
      • Unable to respond in anyway except eye movements (Blinking and vertical gazes)
         
  • Internal carotid artery
    • Amaurosis fugax



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