Skip to main content
Log in

The validity of a simple clinical classification of acute ischaemic stroke

  • Original Communication
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

The aim of the study reported here was to test the validity of a simple clinical classification of acute ischaemic stroke (Oxfordshire Community Stroke Project, OCSP) in predicting the site and size of cerebral infarction on computed tomography (CT). Consecutive patients admitted to hospital with acute ischaemic stroke were prospectively identified and classified into one of four clinical syndromes according to the OCSP classification, blind to the result of CT. The CT brain scans were classified blind to the clinical features into those demonstrating: small, medium or large cortical infarcts; small or large subcortical infarcts in the anterior circulation territory; and posterior cerebral circulation territory infarcts. A total of 108 patients were included. A recent infarct was seen. on the CT scan in 91 patients (84%), and the clinical classification correctly predicted the site and size of the cerebral infarct in 80 of these (88%; 95% confidence interval 77–92%). The positive predictive value was best for large cortical infarcts (0.94) and worst for small subcortical infarcts (0.63). The OCSP clinical classification is a reasonably valid way of predicting the site and size of cerebral infarction on CT and can, therefore, be used very early after stroke onset before the infarct appears on the scan.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Adams HP, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh EE, TOAST investigators (1993) Classification of subtype of acute ischaemic stroke: definitions for use in a multicenter clinical trial. Stroke 24:35–41

    PubMed  Google Scholar 

  2. Adams RJ, Meador KJ, Sethi KD, Grotta JC, Thomson DS (1987) Graded neurological scale for use in acute hemispheric stroke treatment protocols. Stroke 18:665–669

    PubMed  Google Scholar 

  3. Bamford J, Sandercock PAG, Dennis M, Bum J, Warlow CP (1991) Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet 337:1521–1526

    PubMed  Google Scholar 

  4. Candelise L (1992) Stroke scores and scales. Cerebrovasc Dis 2:239–247

    Google Scholar 

  5. Chambers BR, Brooder RJ, Donnan GA (1991) Proximal posterior cerebral artery occlusion simulating middle cerebral artery occlusion. Neurology 41:385–390

    PubMed  Google Scholar 

  6. Cote R, Hachinski VC, Shurvell BL, Norris JW, Wolfson C (1986) The Canadian neurological scale: a preliminary study in acute stroke. Stroke 17:731–737

    PubMed  Google Scholar 

  7. Damasio H (1983) A computed tomographic guide to the identification of cerebral vascular territories. Arch Neurol 40:138–142

    PubMed  Google Scholar 

  8. Lindley RI, Warlow CP, Wardlaw JM, Dennis MS, Slattery J, Sandercock PAG (1993) Interobserver reliability of a clinical classification of acute cerebral infarction. Stroke 24:1801–1804

    PubMed  Google Scholar 

  9. National Institute of Neurological Disorders and Stroke (1990) Classification of cerebrovascular diseases III. Stroke 21:637–676

    Google Scholar 

  10. Naylor AR, Sandercock PAG, Sellar RJ, Warlow CP (1993) Patterns of vascular pathology in acute, first-ever cerebral infarction. Scott Med J 38:41–44

    PubMed  Google Scholar 

  11. Shinar D, Gross CR, Mohr JP, Caplan LR, Price TR, Wolf PA, Hier DB, Kase CS, Fishman IG, Wolf CL, Kunitz SC (1985) Interobserver variability in the assessment of neurologic history and examination in the Stroke Data Bank. Arch Neurol 42:557–565

    PubMed  Google Scholar 

  12. Shuaib A, Lee D, Pelz D, Fox A, Hachinski VC (1992) The impact of magnetic resonance imaging on the management of acute ischaemic stroke. Neurology 42:816–818

    PubMed  Google Scholar 

  13. Wood-Dauphinee SL, Williams JI, Shapiro SH (1990) Examining outcome measures in a clinical study of stroke. Stroke 21:731–739

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wardlaw, J.M., Dennis, M.S., Lindley, R.I. et al. The validity of a simple clinical classification of acute ischaemic stroke. J Neurol 243, 274–279 (1996). https://doi.org/10.1007/BF00868526

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00868526

Key words

Navigation