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Large-vessel ischemic stroke — RCPSC IM MCQ

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HardNeurologyLarge-vessel ischemic strokeRCPSC IM

A 69-year-old presents with a severe disabling stroke, NIHSS 20, and no hemorrhage on CT. What vascular imaging should be obtained immediately while reperfusion treatment is prepared?

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Correct answer: A — Obtain CT angiography of the head and neck

The best answer is “Obtain CT angiography of the head and neck”. Rapid head-and-neck CTA identifies proximal large-vessel occlusion and guides EVT transfer or treatment. It is performed in parallel with eligible thrombolysis, not after delay; carotid Doppler does not adequately assess the intracranial circulation.

Reference: Canadian Stroke Best Practices, acute ischemic stroke treatment: https://www.strokebestpractices.ca/recommendations/acute-stroke-management/acute-ischemic-stroke-treatment