Haemorrhagic transformation after thrombolysis — SCE Neurology MCQ

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ModerateStrokeHaemorrhagic transformation after thrombolysisSCE Neurology

A 18-year-old man presented with worsening headache and neurological decline after alteplase for ischaemic stroke. On examination, blood pressure rose and conscious level fell. Initial investigations showed: urgent CT showed haemorrhage within the infarct bed. What is the most appropriate investigation?

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Correct answer: B — CT angiography of the head and neck

CT angiography of the head and neck is the best answer because the vignette describes Haemorrhagic transformation after thrombolysis: acute deterioration after thrombolysis requires CT to exclude haemorrhage. CSF JC virus PCR is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. EEG with sleep-deprived recording and Carotid duplex ultrasound are less appropriate because they would require different localisation, timing or test findings; Genetic testing after counselling would fit a different syndrome. Clinical pearl: post-stroke oedema is possible but CT confirms bleeding here.

Reference: NICE NG128; National Clinical Guideline for Stroke; DVLA Assessing fitness to drive