Question

A 78-year-old woman presents with sudden onset right-sided weakness and expressive aphasia that began 45 minutes ago. Her blood pressure is 175/95 mm Hg, glucose is 6.0 mmol/L and there are no contraindications to thrombolysis. CT head shows no haemorrhage or early infarct signs. According to Canadian Stroke Best Practice Recommendations, what is the most appropriate next step?

Accepted Answer

Administer intravenous tissue plasminogen activator within the emergency department and target door-to-needle time ≤30 minutes.

Answer

Arrange urgent CT angiography and defer thrombolysis until a large-vessel occlusion is confirmed.

Answer

Begin dual antiplatelet therapy with acetylsalicylic acid and clopidogrel instead of thrombolysis.

Answer

Delay thrombolysis until blood pressure is reduced to <140/90 mm Hg using intravenous labetalol.

Answer

Transfer the patient to a stroke unit and initiate rehabilitation without reperfusion therapy because she is over 75 years old.

Practice question