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Acute Ischaemic Stroke — RACP Adult Medicine MCQ

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EasyNeurologyAcute Ischaemic StrokeRACP Adult Medicine

A 68-year-old man presents with sudden onset of right-sided weakness and expressive aphasia 90 minutes ago. CT brain shows no haemorrhage. BP is 175/95 mmHg. Weight is 85 kg. What is the most appropriate acute treatment?

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Correct answer: C — IV alteplase

Acute ischaemic stroke within 4.5 hours of symptom onset without contraindications warrants IV thrombolysis with alteplase (0.9 mg/kg, max 90 mg; 10% as bolus, remainder over 60 minutes). BP should be maintained <185/110 mmHg before and during thrombolysis. LVO assessment for possible thrombectomy should occur simultaneously.

Reference: Stroke Foundation Australia – 2024 – Clinical Guidelines for Stroke Management