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Neurology — SCE Neurology MCQ

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HardDAWN/DEFUSE‑3 criteria). Thrombolysis window is shorter; antiplatelet alone or anticoagulation is not appropriate initial therapy."NeurologySCE Neurology

A patient with a disabling anterior-circulation stroke presents 11 hours after last known well. CT shows a small core and CT perfusion shows substantial salvageable tissue; CTA confirms an internal-carotid terminus occlusion. What is the priority?

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Correct answer: C — Urgent transfer for mechanical-thrombectomy assessment under late-window imaging criteria

The best answer is “Urgent transfer for mechanical-thrombectomy assessment under late-window imaging criteria”. NICE supports thrombectomy up to 24 hours in selected anterior-circulation occlusion when advanced imaging shows salvageable tissue. “Aspirin alone because all reperfusion ends at six hours” is plausible in a different neurological context, but the decisive findings here argue against it. “Therapeutic heparin to dissolve the arterial embolus” is plausible in a different neurological context, but the decisive findings here argue against it. “Delay repeat perfusion imaging until 24 hours” is plausible in a different neurological context, but the decisive findings here argue against it. “Intravenous thrombolysis without checking time or eligibility” 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