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Types of stroke

  • Ischaemic stroke (risk factors: age, AF, diabetes, hypertension, obesity, hypercholesterolaemia, smoking, obesity, family history)
    • Total anterior circulation stoke (TACS) 3/3 of – Higher function (speech/apraxia/neglect), Hemianopia, Hemi-loss (motor/sensory)
    • Partial anterior circulation stroke (PACS) 2/3  of – Higher function (speech/apraxia/neglect), Hemianopia, Hemi-loss (motor/sensory)
    • Lacunar stroke (LACS) 1/3 of – Higher function (speech/apraxia/neglect), Hemianopia, Hemi-loss (motor/sensory)
    • Posterior circulation stroke (POCS) – vertebrobasilar arterial system occlusions
      • Occipital → isolated contralateral homonymous visual field defect
      • Cerebellar → ipsilateral cerebellar signs
      • Brainstem → ipsilateral cranial nerve palsies, bilateral sensory/motor deficit, disorder of eye movements
  • Intracerebral haemorrhage (risk factors: age, anticoagulation, alcohol, hypertension, stress, smoking)

Possible clinical features by vascular territory

Circle of Willis

NB: carotid artery dissection is a cause of anterior circulation stroke and vertebral artery dissection is a cause of posterior circulation stroke. Think about dissection if there is neck pain, the patient is young or there is associated trauma.

Investigations and management

See acute management notes on stroke