Background: Hyperdense arteries in cranial CT of acute stroke patients have been described as a sign for acute ischemia in various brain-feeding arteries. However, only 1 case of a hyperdense anterior cerebral artery sign (HACAS) has been published to date. In this study, the frequency and association of HACAS with clinical symptoms and outcome are described.
Methods: Our radiological databases were searched for patients with infarcts in the territory of the anterior cerebral artery (ACA). Only patients who received an initial CT and a follow-up CT or MRI were included. The presence of a HACAS was rated by 2 independent observers using the Cohen kappa-statistics. Further data recorded were early ischemic signs, final size of infarct, symptoms, initial NIHSS (National Institute of Health Stroke Scale) score, latency between symptom onset and initial CT, etiology, modified Rankin Scale (mRS) score at discharge and secondary hemorrhage.
Results: A HACAS could be visualized in 11/24 patients (46%). Interobserver agreement was substantial with Cohen's kappa = 0.66. Patients with a HACAS had a significantly higher NIHSS score (9.45 +/- 8.41; median: 8) than those without (3.69 +/- 2.09; median: 4). A HACAS was visible more frequently when the CT was performed early (<2.5 h after symptom onset). There was no correlation with single symptoms, size of infarct, etiology, mRS or the tendency to hemorrhage.
Conclusions: HACAS is associated with a higher NIHSS score. It is an early sign of ischemia which can be reversible over time. It can be helpful in the detection of ischemia in the territory of the ACA.