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Posterior circulation stroke — RCPSC EM MCQ

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HardNeurological emergenciesPosterior circulation strokeRCPSC EM

A 62-year-old has abrupt vertigo, diplopia, vomiting and inability to walk. Head impulse is normal, skew is present and non-contrast CT head is normal; onset was 90 minutes ago. What is the most appropriate next step?

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Correct answer: B — Activate the stroke pathway for urgent vascular imaging and reperfusion assessment

The best answer is “Activate the stroke pathway for urgent vascular imaging and reperfusion assessment”. The bedside findings and disabling gait impairment are concerning for posterior-circulation stroke. Normal non-contrast CT does not exclude early ischaemia, and a low NIHSS can underrepresent posterior deficits. Canadian stroke guidance requires immediate assessment, imaging and reperfusion eligibility decisions without delay; symptomatic treatment cannot replace a stroke pathway.

Reference: Canadian Stroke Best Practices: Emergency Department Evaluation and Management of Acute Stroke: https://www.strokebestpractices.ca/recommendations/acute-stroke-management/emergency-department-evaluation-and-management