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BACKGROUND : Subclassification of cerebral infarcts is crucial in order to optimise and differentiate therapy. If we are to apply specific treatment modalities early while neurological deficits are still reversible, we need a fast diagnosis that reliably predicts etiology. MATERIAL AND METHODS : The early clinical classification into Oxford subgroups is presented with an assessment of their predictive value in relation to aetiology (TOAST classification). RESULTS : The various Oxford subgroups correlate well to the topography of the infarction demonstrated by neuroradiology, to the vascular aetiology as demonstrated by ultrasound techniques, and to the "aetiologic" subgroup as determined by a full diagnostic work-up. However, the correlation is not sufficient to guide potentially specific treatments of subgroups if the treatment in question has serious side effects (e.g. thrombolysis). However, if the clinical diagnosis is supplemented with diffusion-weighted MRI and perhaps MR angiography, the predictive value of the diagnosis is extremely high. INTERPRETATION : Very early clinical diagnosis of cerebral infarction must be supplemented with diffusion-weighted MRI to make the diagnostic precision sufficiently high to guide the application of specific treatments with potentially serious side effects.

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