Facharzt FMH Neurologie Practice Questions - Facharzt FMH Für Neurologie Spécialiste FMH En Neurologie Exam

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A 68-year-old man presents to the emergency department 1 hour and 45 minutes after the sudden onset of right-sided hemiparesis and global aphasia (NIHSS 16). Non-contrast head CT shows no acute intracranial hemorrhage and an ASPECTS score of 9 (subtle hypoattenuation in the lentiform nucleus). Blood pressure is 172/94 mmHg, blood glucose is 6.2 mmol/L (112 mg/dL), and platelet count is 240,000/mcL. He takes aspirin 100 mg daily for primary prevention. According to European Stroke Organisation (ESO) and Swiss Neurological Society guidelines, what is the most appropriate immediate medical management?

Initiate intravenous thrombolysis with alteplase (0.9 mg/kg) or tenecteplase (0.25 mg/kg) immediately while proceeding to CT angiography Withhold intravenous thrombolysis because the patient is taking daily aspirin and administer clopidogrel 300 mg loading dose Administer intravenous labetalol to lower systolic blood pressure below 140 mmHg before considering thrombolysis Defer systemic thrombolysis and perform primary catheter angiography for intra-arterial thrombectomy alone

Correct Answer:

Initiate intravenous thrombolysis with alteplase (0.9 mg/kg) or tenecteplase (0.25 mg/kg) immediately while proceeding to CT angiography

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