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Background: The Oxfordshire Community Stroke Project clinical classification of ischemic stroke syndromes has been shown to be predictive of important clinical outcomes. In this study, we examined the correlation between this classification system and infarct topography on computed tomography (CT) of the brain. Method: A cohort of consecutive cases of acute ischemic stroke admitted to an acute stroke service during the 3-year period ending December 31, 1996 were identified from a prospective stroke registry. Brain scans were reviewed by a single neuroradiologist without knowledge of the clinical features. Results: There were 418 patients with acute ischemic stroke who met the study admission criteria. Forty patients were excluded, 20 (5%) did not have a CT scan during the admission, and 20 scans were not available for review. In 239 of 378 patients (63%), the brain scan revealed the lesion responsible for the clinical syndrome. In patients with positive scans, the positive predictive values of the clinical subtypes were: 86% (95% confidence interval, 78–94) for the total anterior territory stroke syndrome, 96% (92–100) for the partial anterior territory stroke syndrome, 99% (97–100) for the lacunar stroke syndrome, and 100% for the posterior circulation stroke syndrome. Conclusion: The Oxfordshire Community Stroke Project classification of ischemic stroke syndromes usefully predicts infarct topography on CT scan.

Stroke is a leading cause of serious and long-term disability and death worldwide, with approximately 750,000 strokes occurring annually in the United States of America. The risk of stroke doubles each decade for people over 55 years. Cerebral angiography conducted soon after the onset of stroke demonstrates arterial occlusion in 70%-80% of cases. Recanalization of an occluded cerebral artery may assist in the recovery of reversibly ischemic tissue and limit the neurological disability. In June 1996, the recombinant tissue plasminogen activator was approved as a safe and an effective intravenous treatment for acute ischemic stroke, especially if given within 3 hours of onset of symptoms. Since approval, less than 5% of all stroke patients are receiving recombinant tissue plasminogen activator. In this review we try to answer the question of whether recombinant tissue plasminogen activator therapy should be the first-line treatment for acute ischemic stroke. The result of major recombinant tissue plasminogen activator trials will be summarized and reviewed critically.