Total anterior circulation infarct

Total Anterior Circulation Infarct (TACI) is a type of ischemic stroke that involves the extensive area of the anterior circulation of the brain. This condition is characterized by the involvement of the internal carotid artery territory, which significantly impacts the middle cerebral artery (MCA) and often the anterior cerebral artery (ACA). TACIs account for a significant proportion of ischemic strokes and are associated with severe clinical outcomes due to the large brain area affected.

Etiology

TACI is primarily caused by atherosclerosis leading to thromboembolism, which blocks the blood flow in the internal carotid artery or one of its major branches, such as the MCA or ACA. Other causes may include cardiac embolism, where clots formed in the heart are dislodged and travel to the brain, and arterial dissection.

Clinical Presentation

Patients with Total Anterior Circulation Infarct typically present with a combination of symptoms, including:

• Hemiplegia or severe weakness on one side of the body
• Hemianesthesia, or loss of sensation on one side of the body
• Homonymous hemianopia, which is loss of vision in the same visual field of both eyes
• Cognitive impairments, including aphasia (if the dominant hemisphere is involved) or apraxia and neglect (if the non-dominant hemisphere is affected)

Diagnosis

Diagnosis of TACI involves clinical assessment using the National Institutes of Health Stroke Scale (NIHSS) to evaluate the severity of the stroke. Imaging studies, particularly magnetic resonance imaging (MRI) or computed tomography (CT) scans, are crucial for confirming the diagnosis, assessing the extent of the brain damage, and determining the exact location of the blockage or clot.

Treatment

The treatment of Total Anterior Circulation Infarct aims to restore blood flow to the affected area as quickly as possible. This may involve:

• Thrombolysis with intravenous tissue plasminogen activator (tPA), if administered within 4.5 hours of symptom onset
• Mechanical thrombectomy, a procedure to physically remove the clot, which can be performed within 24 hours of symptom onset in certain cases
• Management of risk factors, such as hypertension, diabetes, and hyperlipidemia, to prevent further strokes
• Rehabilitation services, including physical therapy, occupational therapy, and speech therapy, to help recover lost functions

Prognosis

The prognosis for patients with Total Anterior Circulation Infarct is generally poor due to the extensive brain area affected. The mortality rate is high, and survivors often experience significant disabilities. Early recognition and treatment are critical to improving outcomes.

Prevention

Prevention of TACI involves managing the underlying risk factors for stroke, such as controlling blood pressure, maintaining a healthy diet, regular exercise, avoiding smoking, and managing diabetes.