Medical Students
Think like a
Think like a
Clinical Detective.
Stop passively reading textbooks. Engage with interactive patient cases, highlight key findings, and build your diagnostic reasoning.
CASE #402
14:00 PM
Patient is a 55-year-old male presenting with
retrosternal chest pain
radiating to the
left arm.
He reports associated
diaphoresis.
ECG shows
ST-segment elevation.
STEMI CONFIRMED
Sudden Onset Neurological Deficits
A 72-year-old man is brought to the emergency department with a sudden onset of neurological deficits that started 2 hours ago. On examination, he is found to have severe right-sided hemiparesis affecting the face, arm, and leg. He has global aphasia and is unable to follow commands. Visual field testing demonstrates a right homonymous hemianopia. An urgent CT scan of the head excludes intracerebral haemorrhage.
Key Findings
- Motor: Severe R-Hemiparesis (Face, Arm, Leg)
- Higher Function: Global Aphasia
- Visual: R-Homonymous Hemianopia
- CT: No Haemorrhage
Case Solved: Correct!
Analysis
According to Davidson’s 24th Edition (Fig 29.7), a Total Anterior Circulation Syndrome (TACS) is defined by the combination of three specific features:
- Hemiparesis affecting at least two of the face, arm, and leg.
- Higher cerebral dysfunction (e.g., dysphasia).
- Homonymous hemianopia.
This patient presents with all three key features. Therefore, TACS is the correct classification.
Why Others are Incorrect
A. PACS (Partial)
Diagnosed if only two of the three components are present, or isolated higher dysfunction. This patient has all three.
Ref: Davidson’s 24e, Page 1209
B. LACS (Lacunar)
These are “pure” motor or sensory strokes. They specifically lack higher cerebral dysfunction (aphasia) and visual field loss.
Ref: Davidson’s 24e, Page 1209
C. POCS (Posterior)
Involves vertebrobasilar territory (cerebellar signs, cranial nerve palsies). It does not cause global aphasia.
Ref: Davidson’s 24e, Page 1209