A 67-year-old male presents to the emergency department with a 2-hour history of sudden onset right-sided weakness, difficulty forming words, and vision loss in both eyes. On examination, you identify right-sided hemiparesis, loss of the temporal visual fields in his right eye and nasal visual fields in his left eye. You also note that he has difficulty forming words, but the meaning is preserved. After further investigation, you diagnose an ischaemic stroke.

Which of the following stroke classifications has this patient suffered?

Options:
explanation: Although this man meets the criteria for a TACS, it is left-sided (most likely left middle or anterior cerebral artery). We know this because his hemiparesis is right-sided and the left hemisphere is responsible for right-sided motor control. Furthermore, the homonymous hemianopia described is right-sided, and the right visual fields are processed by the left hemisphere. Lastly, he suffers from Broca's aphasia which occurs due to damage to the Broca's area, which is located in the left frontal lobe in most people.
name: Right Total Anterior Circulation Stroke
label: b
answer: no
explanation: This patient has suffered a left total anterior circulation stroke (TACS). There are three criteria to diagnose a TACS: unilateral hemiparesis (+/- a sensory deficit) AND a homonymous hemianopia AND evidence of higher cerebral dysfunction (e.g. dysphasia or visuospatial dysfunction). This man has all three. Furthermore, his symptoms are right-sided (right hemiparesis, right homonymous hemianopia) and he suffers damage to Broca's area which is located in the dominant hemisphere. Therefore we know this man has had a left TACS.
name: Left Total Anterior Circulation Stroke
label: a
answer: yes
explanation: This patient is suffering from neither a right-sided stroke nor a PACS. This patient meets all 3 criteria for diagnosis of a TACS, whereas a PACS would be diagnosed if only 2 criteria were met. Additionally, this patient's hemiparesis is right-sided and the left hemisphere is responsible for right-sided motor control. Furthermore, the homonymous hemianopia described is right-sided, and the right visual fields are processed by the left hemisphere. Lastly, he suffers from Broca's aphasia which occurs due to damage to the Broca's area, which is located in the left frontal lobe in most people.
name: Right Partial Anterior Circulation Stroke
label: d
answer: no
explanation: Although this man has suffered a left-sided stroke, he meets all criteria for diagnosis of a TACS, not a posterior circulation stroke (POCS). A POCS would be diagnosed if one of the following is present: cranial nerve palsy with contralateral motor/sensory deficit, bilateral motor/sensory deficit, conjugate eye movement disorder, evidence of cerebellar dysfunction, or isolated homonymous hemianopia.
name: Left Posterior Circulation Stroke
label: e
answer: no
explanation: Although this man has suffered a left-sided stroke, it involves the total anterior circulation, not partial anterior circulation. A partial anterior circulation stroke (PACS) features 2 of the 3 criteria for TACS. This patient features all criteria to diagnose a TACS however, so PACS is incorrect.
name: Left Partial Anterior Circulation Stroke
label: c
answer: no

Correct answer: a