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Acute ischaemic stroke thrombolysis — SCE Neurology MCQ

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EasyStrokeAcute ischaemic stroke thrombolysisSCE Neurology

A 71-year-old woman develops sudden right hemiparesis and expressive dysphasia 70 minutes before arrival. CT brain excludes haemorrhage and glucose is normal. Blood pressure is 174/92 mmHg and she takes no anticoagulant. NIHSS is 9. What is the most appropriate management?

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Correct answer: A — Intravenous alteplase after stroke-team assessment

Intravenous alteplase after stroke-team assessment is the best answer. She presents within the thrombolysis window with disabling ischaemic stroke and no listed contraindication, so IV alteplase after specialist assessment is appropriate. Antiplatelets should not precede thrombolysis; carotid surgery is not hyperacute treatment; thrombectomy requires vascular imaging and large-vessel occlusion; waiting loses treatment benefit. Clinical pearl: Non-contrast CT first answers the haemorrhage question, not the reperfusion question.

Reference: NICE NG128; RCP National Clinical Guideline for Stroke