PS
PathoSchema® by Astavalence
Comprehensive Ischaemic Stroke Simulator
Interactive vascular localisation with real-time examination and imaging correlation
1 hourLarge penumbra · small core
Immersive anatomy and pathophysiology
Left MCA M1
Drag the thrombus on the arterial map. The axial brain, patient examination model, visual fields and radiology previews all update to show what changes with this specific ischaemic event.
L M1dominant cortical syndrome
Axial arterial brain map
Grey matter, white matter, ventricles, Circle of Willis, tissue at risk and core-penumbra evolution
InteractionDrag the thrombus or use the selector. The simulator updates the patient examination, visual fields and imaging findings in real time.
Axial map teaching point
Core: 18%Penumbra: 82%
Current syndrome and pathway
Clinical summary, NICE-based investigations and management
1. Rapid recognition+
Use FAST outside hospital and ROSIER in the emergency department. Exclude hypoglycaemia early because it can mimic stroke. Suspected stroke requires immediate specialist pathway activation.
2. Immediate investigation strategy+
- Urgent non-contrast CT to separate ischaemic stroke from haemorrhage.
- CTA when large vessel occlusion or thrombectomy is being considered.
- MRI DWI and, where relevant, FLAIR when tissue confirmation or onset clarification is useful.
- ECG, capillary glucose and baseline bloods as part of the early pathway.
3. Core and penumbra concept+
Earlier after occlusion, infarct core is smaller and salvageable penumbra is larger. As time passes, core expands and penumbra shrinks. Real patients vary according to collateral flow, vessel size, blood pressure and reperfusion status.
4. Early management priorities+
Management summary
Micro clinical reasoning
Click to test understanding
Why does a large M1 occlusion make CTA especially valuable?
Because a proximal MCA syndrome raises the probability of a treatable large vessel occlusion, so vessel imaging becomes decisive for thrombectomy pathway decisions.
If the leg is predominantly weak with relatively less face and arm involvement, which territory is more likely?
ACA territory, because the medial frontal and parietal cortex contains the leg-dominant motor and sensory representation.
Why can early CT appear almost normal while DWI already shows infarction?
Early CT changes can be subtle; DWI detects restricted diffusion very early in the infarct core.
What makes basilar occlusion a different examination category?
The pattern is brainstem/posterior circulation dominant: diplopia, dysarthria, dysphagia, ataxia, reduced consciousness and possible bilateral weakness.
Educational simulator only. Clinical syndromes are simplified to teach localisation clearly; local stroke pathways and senior clinical judgement override any teaching model.