The finding of a hyperdense lesion in the ACA on CT scan aid in the diagnosis of stroke in its acute phase, particularly when it may be otherwise difficult to establish. The frequency of this sign in ACA infarcts is similar to that in the territories of the middle cerebral artery and the posterior circulation. [19]
As in strokes involving other areas of the brain, magnetic resonance imaging is also of critical value in the diagnosis of ACA strokes. MRI with diffusion-weight imaging is a highly useful modality, which facilitates the demarcation of ischemic boundaries in the territory of the ACA. [3] [18] MR angiography can be a helpful adjunct in the evaluation of stroke mechanisms. [7] The goal of completing head CT or MRI should be 25 min or less within patient arrival. The National Institutes of Neurological Disorders and Stroke (NINDS) established time frame goals in the evaluation of stroke patients: door to physician less than 10 min, door to stroke team less than 15 min, door to CT scan less than 25 min, door to drug less than 60 min. [20]
Along with accurate history and early imaging, laboratory studies including capillary blood glucose, complete blood count with platelets, chemistries, coagulation studies, hemoglobin A1c, lipid panel, and markers of hypercoagulability or inflammation can be useful in identifying the risk factors or establishing the etiology of stroke. The medication checklist is an integral part of the evaluation, specifically recent use of anticoagulants, as contraindications to thrombolytic therapy should undergo rapid assessment.
While being the most effective therapy, radiation has shown damaging effects on the already compromised intellect as well as an increase in vascular issues & second tumor formation in children with neurofibromatosis 1. However, fractionated stereotactic radiation therapy (FSRT) is gaining traction as the most preferred interventional treatment for optic nerve glioma due to its combination of the therapeutic efficiency of radiation therapy without the negative side effects. Chemotherapy has also been shown to be a safer alternative to most radiation therapies & surgery for very young children (under the age of 3). However, the optimal chemotherapeutic therapy has not been defined, with risks of different toxicities still observed in older children. Surgery is considered the final choice of treatment, due to the high risk of blindness & damage to the affected eye. It is considered in only certain scenarios, such as relieving a cosmetically unappealing bulging eye (exophthalmos), removing an enlarging and/or expanding tumor or a combination of both. Prognosis
Optic gliomas alternate between periods of inactivity and growth, making their clinical presentation variable & clinical course unpredictable. Once the optic chiasm is involved, the prognosis for life & vision worsens. References
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