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

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A 62-year-old woman awakens at 07:00 with severe left-sided hemiparesis and spatial neglect. She was last seen in her normal state of health at 22:30 when going to sleep. She arrives at the stroke center at 08:30. Multimodal brain MRI demonstrates acute diffusion restriction in the right middle cerebral artery (MCA) territory on diffusion-weighted imaging (DWI) without corresponding signal hyperintensity on fluid-attenuated inversion recovery (FLAIR) imaging. CT/MR angiography reveals no large vessel occlusion. Based on the WAKE-UP trial and current ESO guidelines, what is the best management strategy?

Withhold intravenous thrombolysis and administer aspirin 300 mg orally, as symptom onset was >4.5 hours ago Administer intravenous thrombolysis with alteplase based on the positive DWI-FLAIR mismatch Initiate therapeutic dose low-molecular-weight heparin (LMWH) for non-large vessel wake-up stroke Perform emergency stereotactic burr-hole craniostomy to relieve impending cerebral edema

Correct Answer:

Administer intravenous thrombolysis with alteplase based on the positive DWI-FLAIR mismatch

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