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Acute ischaemic stroke — MCCQE Part 1 MCQ

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HardWeaknessAcute ischaemic strokeMCCQE Part 1

A 68-year-old woman arrives 80 minutes after sudden right-sided weakness and aphasia. BP is 168/88 mmHg, glucose is 5.8 mmol/L, and non-contrast CT head shows no haemorrhage. She takes no anticoagulants. What is the most appropriate next step in management?

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Correct answer: D — Give intravenous thrombolysis after stroke-team assessment

Disabling ischaemic stroke within the thrombolysis window with haemorrhage excluded should be considered for intravenous thrombolysis after rapid stroke-team assessment. Aspirin is important when thrombolysis is not given, but it should not precede a thrombolysis decision. MRI may help in selected cases but should not delay eligible reperfusion. Carotid surgery is not the acute first step in the emergency department.

Reference: Canadian Stroke Best Practices