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Acute ischaemic stroke with large-vessel occlusion — SCE Acute Medicine MCQ

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HardNeurology and ophthalmologyAcute ischaemic stroke with large-vessel occlusionSCE Acute Medicine

A 63-year-old woman develops sudden right-sided weakness and expressive dysphasia 80 minutes before arrival. Capillary glucose is 6.4 mmol/L and BP is 176/94 mmHg. CT head shows no haemorrhage. CT angiography shows a proximal left middle cerebral artery occlusion. She was independent before this event and has no anticoagulant use. What is the most appropriate next step in management?

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Correct answer: E — Give intravenous thrombolysis and arrange urgent transfer for thrombectomy

This is an acute disabling ischaemic stroke within the thrombolysis window with a proximal anterior circulation occlusion. NICE recommends thrombolysis when eligible and thrombectomy as soon as possible for suitable large-vessel occlusion, without delaying transfer. Aspirin is delayed until haemorrhage has been excluded and usually after thrombolysis timing has been addressed.

Reference: NICE NG128; National Clinical Guideline for Stroke 2023