An 81-year-old female presents to ER. Her son gives a collateral history, as the patient is very difficult to understand. He repos that the patient has had difficulty walking and could not lift her left arm for the past hour. He has also noticed the patient's speech doesn't make sense. O/E-The patient is right-handed. There is reduced power (MRC 2/5) and flaccidity in the left arm and leg. Light touch sensation is also decreased on the left arm and leg. The right arm and leg appear normal. Visual fields are normal, but there is a detion of both eyes to right. According to the Oxford Classification of Stroke, what type of stroke is this ?
-Difficulty walking, difficulty in movements- DYSAHRIA (unclear speech). -Visual field are N but optic detion in both eyes i.e optic radiation to the contralateral side at the site of lesion as in coical stroke can be seen. Therefore, here problem in LEFT side, patient's eyes is deted to contra lateral side/towards the side of stroke. Since the question mentions weakness in the arms & legs we can diagnose it as Ant. CIRCULATION. Option C- gait ataxia and cerebellar damage features not mentioned & cannot be the answer. Option D- Causes either pure motor or pure sensory but here there is motor+ sensory involvement affected. Oxford Stroke Classification Type of infarct Criteria and features Total anterior circulation infarct (TACI) Combination of all 3: 1. Unilateral hemiparesis and/or hemisensory loss of face, arm and legs-(motor and sensory coex affected) 2. Homonymous hemianopia (involvement of the optic radiation) 3. Higher cognitive dysfunction: - Expressive or receptive Dysphasia (Dominant hemisphere involved) - Visual and sensory inattention - Neglect(Non dominant hemisphere involved) Paial anterior circulation infarcts (PACI) 2/3 of the criteria for TACI Lacunar Infarction (LACI) Coex is spared(No higher coical function defect) One of the following is needed for diagnosis: - Pure motor hemiparesis - Pure hemi sensory loss - Sensorimotor stroke - Ataxic hemiparesis - Dysahria Posterior Circulation Infarction (POCI) "Crossed" syndromes, with I/L cranial nerve palsy C/L motor and/or sensory deficit Features include: - Ataxia - Cerebellar syndrome - Horner's Syndrome - Isolated homonymous hemianopia (occipital lobe supplied by posterior cerebral aery) - Coical blindness (basilar aery occlusion affecting both occipital coices)
Total Anterior Circulation Infarction
Paial Anterior Circulation Infarction
Superior Cerebellar Aery Infarction
Lacunar Infarction
Stroke and TIA