Neurology — SCE Neurology MCQ

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HardEarly Management of Acute Ischemic StrokeNeurologySCE Neurology

A patient awakens with disabling aphasia. MRI shows a small DWI-positive lesion without corresponding FLAIR hyperintensity, and haemorrhage is excluded. Which reperfusion implication is most accurate?

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Correct answer: D — The DWI–FLAIR mismatch can support thrombolysis selection

The best answer is “The DWI–FLAIR mismatch can support thrombolysis selection”. The imaging mismatch estimates recent tissue injury and is used in selected wake-up strokes; it does not replace all clinical and vascular eligibility checks. “Unknown onset absolutely excludes all intravenous thrombolysis” is plausible in a different neurological context, but the decisive findings here argue against it. “The mismatch proves a completed infarct and mandates anticoagulation” is plausible in a different neurological context, but the decisive findings here argue against it. “Normal FLAIR excludes ischaemia and requires discharge” is plausible in a different neurological context, but the decisive findings here argue against it. “The mismatch alone establishes a large-vessel occlusion requiring thrombectomy” is plausible in a different neurological context, but the decisive findings here argue against it.

Reference: NICE NG128 stroke and transient ischaemic attack recommendations: https://www.nice.org.uk/guidance/ng128/chapter/recommendations