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Acute ischaemic stroke thrombolysis — RACP Adult Medicine MCQ

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HardNeurologyAcute ischaemic stroke thrombolysisRACP Adult Medicine

A 72-year-old woman develops right-sided weakness and aphasia 80 minutes before ED arrival. CT brain shows no haemorrhage and CT angiography shows no large-vessel occlusion. Blood pressure is 178/96 mmHg and glucose is 6.8 mmol/L. There is no anticoagulant use. What is the most appropriate management?

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Correct answer: E — Give intravenous alteplase after confirming eligibility and monitoring blood pressure

She is within the thrombolysis window with disabling ischaemic stroke and no haemorrhage, so IV thrombolysis is appropriate if local criteria are met. Aspirin is delayed until haemorrhage is excluded after thrombolysis. Observation, heparin or outpatient MRI would miss time-critical reperfusion.

Reference: Australian Stroke Foundation Clinical Guidelines; AMH