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Large vessel occlusion stroke — SCE Acute Medicine MCQ

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ModerateAcute Neurological PresentationsLarge vessel occlusion strokeSCE Acute Medicine

A 74-year-old woman presents 4 hours after left hemiplegia, neglect and gaze deviation. CT head shows no haemorrhage and ASPECTS is favourable. CT angiography shows a right M1 middle cerebral artery occlusion. She is independent at baseline. What is the most appropriate next step in management?

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Correct answer: C — Refer urgently for mechanical thrombectomy pathway

A proximal anterior circulation large vessel occlusion with favourable imaging and baseline independence should trigger urgent thrombectomy referral, often alongside thrombolysis if eligible. Aspirin alone is inadequate when reperfusion is possible. Carotid surgery does not treat an acute M1 occlusion. The pearl is that CT angiography is essential in potentially thrombectomy-eligible stroke.

Reference: https://www.nice.org.uk/guidance/ng128#acute-medicine-order-77-1