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.
2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2018 Mar;49(3):e46-e110. [PubMed]
Musuka TD, Wilton SB, Traboulsi M, Hill MD. Diagnosis and management of acute ischemic stroke: speed is critical. CMAJ. 2015 Sep 08;187(12):887-93. [PMC free article] [PubMed]
Uno J, Kameda K, Otsuji R, Ren N, Nagaoka S, Kazushi M, Ikai Y, Gi H. Mechanical Thrombectomy for Acute Anterior Cerebral Artery Occlusion. World Neurosurg. 2018 Dec;120:e957-e961. [PubMed]
Allen CM. Differential diagnosis of acute stroke: a review. J R Soc Med. 1984 Oct;77(10):878-81. [PMC free article] [PubMed]
Guery D, Ong E, Nighoghossian N. Akinetic mutism reversibility after L-dopa therapy in unilateral left anterior cerebral artery infarction. Neurocase. 2017 Apr;23(2):171-172. [PubMed]

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