A 56-year-old repos to the ER and on attempting to take a history, she is having difficulty answering questions. Her daughter repos that this is not normal and gives the history on her mother’s behalf. She repos that, for the past two hours, her mother has been unable to lift her right arm and is struggling walking. On examination, there is reduced power (3/5) in all myotomes of her right arm and leg. There is facial drooping on the right-hand side that spares the forehead. Visual field tests elicit a right homonymous hemianopia. She is unable to speak but is able to follow commands. According to the Oxford Stroke Classification what stroke is this?

**Core Concept**
The Oxford Stroke Classification is a system used to categorize the severity and location of strokes based on the National Institutes of Health Stroke Scale (NIHSS) score. It helps clinicians to quickly identify the type and severity of a stroke, guiding treatment decisions.

**Why the Correct Answer is Right**
The patient presents with a combination of motor deficits (reduced power in all myotomes of the right arm and leg), facial weakness (drooping on the right-hand side that spares the forehead), and visual field impairment (right homonymous hemianopia). These symptoms suggest a large vessel stroke involving the middle cerebral artery (MCA) territory. The inability to speak but ability to follow commands indicates a dominant hemisphere lesion (likely involving Broca's area) but preserved comprehension (Wernicke's area). The Oxford Stroke Classification categorizes strokes based on the NIHSS score, with a score of 6-15 indicating a moderate stroke.

**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect as a NIHSS score of 0-5 would indicate a mild stroke, which does not match the patient's symptoms.
**Option B:** This option is incorrect as a NIHSS score of 16-20 would indicate a severe stroke, which is not consistent with the patient's ability to follow commands.
**Option C:** This option is incorrect as a NIHSS score of 4 would indicate a mild stroke, which does not match the patient's symptoms.

**Clinical Pearl / High-Yield Fact**
The Oxford Stroke Classification is a useful tool for clinicians to quickly identify the severity and location of strokes, guiding treatment decisions. It is essential to remember that the classification is based on the NIHSS score, which assesses 15 items, including level of consciousness, motor function, and language.

**Correct Answer: B. Moderate stroke.**

✓ Correct Answer: B. Total Anterior Circulation Stroke (TACS)