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Acute Ischaemic Stroke — UKMLA MCQ

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HardNeurologyAcute Ischaemic StrokeUKMLAMRCP Part 1MRCEM SBAPARA

An otherwise eligible patient presents within the thrombolysis window for disabling ischaemic stroke, but blood pressure is 198/116 mmHg. What is required before IV thrombolysis?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Lower blood pressure to 185/110 mmHg or less

The best answer is “Lower blood pressure to 185/110 mmHg or less”. Blood pressure must reach 185/110 mmHg or below before IV thrombolysis to limit intracranial-haemorrhage risk. Controlled rapid lowering is used without overshooting and compromising cerebral perfusion. Reperfusion assessment continues in parallel, including thrombectomy evaluation when indicated; aspirin is not given as a substitute during a thrombolysis decision.

Reference: NICE NG128, Stroke and transient ischaemic attack in over 16s: https://www.nice.org.uk/guidance/ng128/chapter/Recommendations