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Acute Ischaemic Stroke – Thrombolysis Eligibility — SCE Neurology MCQ

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EasyCerebrovascular DiseaseAcute Ischaemic Stroke – Thrombolysis EligibilitySCE Neurology

A 78-year-old man presents with a 30-minute history of expressive aphasia without limb weakness. Symptoms began 2 hours ago. CT head is normal. CT angiography shows no large vessel occlusion. His NIHSS score is 5. He has no contraindications to thrombolysis. What is the most appropriate management?

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Correct answer: A — Intravenous alteplase

This patient has an acute ischaemic stroke (expressive aphasia, NIHSS 5) within the 4.5-hour thrombolysis window with no contraindications. Even without a large vessel occlusion (excluding thrombectomy), he is eligible for IV alteplase. NICE NG128 recommends thrombolysis for eligible patients regardless of age. A: Aspirin alone is suboptimal when thrombolysis is available. C: Thrombectomy requires a proximal large vessel occlusion. D: Heparin is not indicated for acute ischaemic stroke. E: Active treatment should not be withheld.

Reference: NICE NG128 (2019, updated 2022)