Front Panel Painting “LIFE” By William T Chua MD

Lacunar syndromes (LACS) include pure motor stroke, pure sensory stroke,
sensorimotor stroke and ataxic hemiparesis. Patients with brain stem or cerebellar
signs, and/or isolated homonymous hemianopia are classified as posterior circulation
syndrome (POCS). Those with total anterior circulation syndromes (TACS), by
definition, present with the triad of hemiparesis (or hemisensory loss), dysphasia (or
other new higher cortical dysfunction) and homonymous hemianopia. Patients with
partial anterior circulation syndrome, by definition, present with only two of the
features of TACS, or isolated dysphasia or parietal lobe signs.
Overview
The Oxfordshire classification was used in a stroke sub-type study among ten Asian
countries which included the Philippines. The breakdown of stroke subtypes in this
study are as follows:
Stroke Sub-Types in 10 Asian Countries 9
All Infarcts 895 (74%)
Partial Anterior Circulation Infarct (PACI) 274 (27%)
Total Anterior Circulation Infarct (TACI) 115 (12%)
Lacunar Infarct (LACI) 247 (25%)
Posterior Circulation Infarct (POCI) 99 (10%)
Parenchymal Intracerebral Hemorrhage 258 (26%)
V.2. Intracranial Versus Extracranial Stenosis
Ischemic strokes can be due to stenosis of blood vessels located inside the skull
(intracranial) or outside the skull (extracranial). Intracranial large artery occlusive
disease is significantly more frequent in Hispanics, Blacks, and Asians, while
extracranial carotid stenosis predominates among Whites. Studies among Chinese,
Taiwanese and Japanese have documented intracranial vascular lesions in 33-67% of
stroke/TIA patients, while extracranial carotid disease in 3-19%. Similar
observations were seen in the St Luke’s stroke data bank where 33% had
atherosclerosis by transcranial duplex exam - 26 % of them with intracranial stenosis
alone, 3.7% had significant extracranial carotid disease alone while another 3.7% had
both intra and extracranial occlusive disease. 9-10
Many prospective studies have confirmed that intracranial stenosis is an independent
predictor for poor outcomes such as recurrent vascular event and death despite the
use of antiplatelet agents. The annual event rate is approximately 15% per year.
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