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Acute ischaemic stroke eligible for thrombolysis — SCE Acute Medicine MCQ

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EasyNeurology and ophthalmologyAcute ischaemic stroke eligible for thrombolysisSCE Acute Medicine

A 72-year-old woman presents 70 minutes after sudden right arm weakness and expressive dysphasia. Capillary glucose is 6.4 mmol/L, NIHSS is 8 and CT head shows no haemorrhage. CT angiography shows no large vessel occlusion. She was independent and takes amlodipine only. What is the most appropriate next step in management?

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Correct answer: E — Give intravenous thrombolysis after confirming eligibility

Disabling ischaemic stroke within the thrombolysis window with haemorrhage excluded should be considered for intravenous thrombolysis after eligibility checks. Aspirin is usually started after haemorrhage is excluded but should not precede thrombolysis in an eligible patient. The absence of large vessel occlusion makes thrombectomy less relevant, not thrombolysis.

Reference: NICE NG128 stroke and transient ischaemic attack