Classifications


Bamford classification / Oxford Stroke Classification

There are many ways of classifying stroke. One commonly accepted method is the Oxford Stroke Classification, also known as the Bamford classification. The Bamford classification divides people with stroke into four different categories, according to the symptoms and signs with which they present. This classification is useful for understanding the likely underlying pathology, which in turn gives information on treatments likely to be useful and the prognosis. It is a relatively simple, robust, bedside classification using clinical information.

A CT scan can be used to further classify the type of stroke into a bleed (intracranial hemorrhage) or an infarction (thomboembolic) stroke. Clinical examination cannot do this reliably, so the CT scan is useful - but it does not make the diagnosis of stroke nor rule it out should the CT scan be normal.

 

Lacunar

Partial anterior circulation

Total anterior circulation

Posterior circulation

Signs

Motor or sensory deficit only

2 of following: motor or sensory deficit; higher cortical dysfunction; hemianopia

All of: motor or sensory; cortical; hemianopia

Isolated hemianopia; brain stem signs; cerebellar ataxia

The easiest way to use the Bamford classification is to look for the presence or absence of the four main features of stroke described above - hemiparesis, higher cortical dysfunction (including language problems), hemianopia and brainstem signs. Once you have this information, you can classify your patient's stroke type: lacunar stroke (LACS), partial anterior circulation stroke (PACS), total anterior circulation stroke (TACS) or posterior circulation stroke (POCS).

TOAST Classification

This is derived from a trial of ORG 10172 in acute stroke treatment (TOAST) classification denotes five sub types of ischaemic stroke.

  • large-artery atherosclerosis (embolus / thrombosis)*
  • cardioembolism (high-risk / medium-risk)*
  • Small-vessel occlusion (lacune)*
  • Stroke of other determined aetiology *
  • stroke of undetermined aetiology

    It is thought to carry good inter observer agreement and predict prognosis, outcome, and management


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