A 55-year-old is brought in with right-sided weakness that started 90 minutes ago. How would you manage this?

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Accepted Answer

This is a hyperacute stroke until proven otherwise. I would activate the stroke pathway, confirm last seen well, perform ABCDE and check capillary glucose to exclude hypoglycaemia. I would calculate the NIHSS and arrange an immediate non-contrast CT head and CT angiography. If ischaemic and within 4.5 hours with no contraindications, I would offer IV thrombolysis with alteplase or tenecteplase per local protocol after consent. If large vessel occlusion is demonstrated, I would refer for mechanical thrombectomy, which is offered up to 24 hours in selected patients. The patient needs admission to a hyperacute stroke unit, swallow screen before oral intake, VTE prophylaxis, and antiplatelet therapy 24 hours post-thrombolysis. I would communicate with the family and document carefully.

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