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Ischaemic stroke within thrombolysis window — SCE Acute Medicine MCQ

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EasyAcute Neurological PresentationsIschaemic stroke within thrombolysis windowSCE Acute Medicine

A 73-year-old woman is assessed on the acute medical unit. She develops sudden right hemiparesis and dysphasia 90 minutes ago. Capillary glucose is normal and blood pressure is 176/94 mmHg. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate investigation?

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Correct answer: A — Non-contrast CT head

Non-contrast CT head is the best answer because urgent brain imaging is required to exclude haemorrhage and assess suitability for reperfusion therapy. Serum osmolality with urine osmolality and sodium is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Stroke thrombolysis decisions are time-dependent and imaging-dependent.

Reference: NICE NG128