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Acute ischaemic stroke eligible for thrombolysis — SCE Acute Medicine MCQ

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ModerateAcute Neurological PresentationsAcute ischaemic stroke eligible for thrombolysisSCE Acute Medicine

A 69-year-old man presents 90 minutes after sudden right-sided weakness and aphasia. Capillary glucose is 5.8 mmol/L. CT head shows no haemorrhage or established large infarct. Blood pressure is 176/94 mmHg and he was not taking anticoagulation. What is the most appropriate next step in management?

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Correct answer: E — Give intravenous thrombolysis after stroke specialist assessment

The patient is within the thrombolysis window with disabling stroke symptoms and no CT haemorrhage, so IV thrombolysis should be considered by the stroke team. Aspirin is deferred until after thrombolysis decisions and post-treatment imaging where applicable. MRI is not required before time-critical treatment when CT is adequate. The pearl is that improving but disabling symptoms can still warrant reperfusion therapy.

Reference: NICE NG128; National Clinical Guideline for Stroke