🧠 The Oxford Community Stroke Project classification (Bamford classification) is widely used to categorise stroke subtypes based on clinical features.
It provides both prognostic and anatomical/etiological insights, useful at the bedside before imaging.
Four main subtypes:
- 🎯 Lacunar Infarcts (LACI)
- 🌐 Total Anterior Circulation Infarcts (TACI)
- 🔻 Partial Anterior Circulation Infarcts (PACI)
- 🌀 Posterior Circulation Infarcts (POCI)
Although first applied to infarcts, the classification can also describe haemorrhagic strokes once imaging clarifies pathology.

Anterior vs Posterior Circulation

➡️ Anterior circulation: internal carotid arteries → ACA & MCA territories (frontal, parietal, lateral temporal lobes).
⬅️ Posterior circulation: vertebrobasilar system → brainstem, cerebellum, occipital lobes, thalamus.
This division underpins the Bamford classification: anterior strokes exclude vertebrobasilar involvement; posterior strokes exclude carotid territory.

📝 Clinical pearl: The Bamford system is based on bedside findings - powerful for rapid classification before CT/MRI.

Classification

🎯 Lacunar Infarcts (LACI):
- Pure motor stroke
- Pure sensory stroke
- Sensorimotor stroke
- Ataxic hemiparesis
- Note: ❌ No higher cortical dysfunction (no aphasia, neglect).
🌐 Total Anterior Circulation Infarcts (TACI): Must have all 3:
- Higher cerebral dysfunction (e.g., dysphasia, neglect)
- Homonymous hemianopia
- Ipsilateral motor/sensory deficit in ≥2 areas (face, arm, leg)
🔻 Partial Anterior Circulation Infarcts (PACI):
- Two of the TACI features, OR
- Higher cerebral dysfunction alone, OR
- More restricted motor/sensory deficit than LACI
🌀 Posterior Circulation Infarcts (POCI): Any of:
- Ipsilateral cranial nerve palsy + contralateral motor/sensory deficit
- Bilateral motor/sensory deficit
- Disorders of conjugate eye movement
- Cerebellar dysfunction
- Isolated homonymous hemianopia

Summary Table

Stroke Type	Features	Vascular Supply	Frequency	6m Fatality	6m Dependency (mRS 3–6)
🌐 TACI	All 3: higher function loss, hemianopia, motor/sensory loss in ≥2 regions	Large MCA/ACA territory	20%	56%	96%
🔻 PACI	2 of 3 TACI features OR higher dysfunction alone OR restricted deficit	Smaller MCA/ACA cortical strokes	35%	10%	45%
🎯 LACI	Pure motor/sensory, sensorimotor, ataxic hemiparesis. ❌ No cortical signs	Lenticulostriate or pontine perforators	25%	7%	34%
🌀 POCI	Cranial nerve palsy + contralateral signs, bilateral deficits, cerebellar/brainstem signs, or isolated hemianopia	Vertebrobasilar or PCA	20–25%	14%	32%

Note: Stroke side = pathology side, not symptom side. Example: Left TACI → right hemiparesis + right hemianopia + dysphasia.

Assessment

Quick bedside check for Bamford classification = look for 4 features:

💪 Hemiparesis or hemisensory loss (face, arm, leg)
🗣️ Higher cortical dysfunction (language/neglect)
👁️ Homonymous hemianopia
🧭 Brainstem/cerebellar signs (vertigo, diplopia, dysphagia, ataxia)

📊 Coding convention: I = Infarct (TACI → TAI) H = Haemorrhage (TACH) S = Syndrome (clinical diagnosis before imaging, e.g. TACS)

References

Bamford et al. Oxfordshire Community Stroke Project, JNNP 1988

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Oxford / Bamford Classification

Introduction

Anterior vs Posterior Circulation

Classification

Summary Table

Assessment

References

Categories