Question

A 68-year-old man presents to the emergency department 2 hours after sudden onset right-sided weakness and aphasia. CT brain shows no haemorrhage. He has no contraindications to thrombolysis. Your hospital uses intravenous alteplase for reperfusion. What is the most appropriate next step?

Accepted Answer

Administer intravenous alteplase at 0.9 mg/kg (maximum 90 mg) as soon as possible

Answer

Start aspirin alone and admit to the stroke unit; thrombolysis is not indicated after 2 hours

Answer

Delay thrombolysis until MRI brain is performed

Answer

Start a therapeutic heparin infusion without thrombolysis

Answer

Arrange elective carotid endarterectomy and defer acute therapy

Practice question

A 68-year-old man presents to the emergency department 2 hours after sudden onset right-sided weakness and aphasia. CT brain shows no haemorrhage. He has no contraindications to thrombolysis. Your hospital uses intravenous alteplase for reperfusion. What is the most appropriate next step?