A 63-year-old arrives 2 hours after witnessed aphasia and right hemiplegia. CT head shows no haemorrhage, CTA shows left M1 occlusion, glucose is

Question

A 63-year-old arrives 2 hours after witnessed aphasia and right hemiplegia. CT head shows no haemorrhage, CTA shows left M1 occlusion, glucose is normal, BP 176/94, and he was well at onset. What is the most appropriate next step?

Accepted Answer

Give thrombolysis if eligible and arrange urgent endovascular thrombectomy transfer

Answer

Observe for spontaneous improvement before neurology referral

Answer

Lower systolic BP below 120 mmHg before reperfusion decisions

Answer

Start therapeutic heparin for presumed embolic stroke

Answer

Give aspirin and discharge if symptoms improve within one hour

Large-vessel ischaemic stroke — RCPSC EM MCQ

A 63-year-old arrives 2 hours after witnessed aphasia and right hemiplegia. CT head shows no haemorrhage, CTA shows left M1 occlusion, glucose is normal, BP 176/94, and he was well at onset. What is the most appropriate next step?