TEN Neurologia Practice Questions - TEN - Título De Especialista Em Neurologia (Academia Brasileira De Neurologia AMB) Exam

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A 62-year-old man presents to the emergency department 75 minutes after the sudden onset of right hemiparesis and global aphasia. His baseline modified Rankin Scale (mRS) is 0. Non-contrast cranial computed tomography (CT) reveals an ASPECTS score of 9 with no acute hemorrhage or early ischemic changes. His blood pressure is 172/96 mmHg, blood glucose is 134 mg/dL, and international normalized ratio (INR) is 1.0. According to current Brazilian and international acute ischemic stroke guidelines, what is the most appropriate immediate medical intervention?

Initiate intravenous thrombolysis with recombinant tissue plasminogen activator (Alteplase 0.9 mg/kg or Tenecteplase 0.25 mg/kg) without waiting for further imaging. Administer oral aspirin 300 mg immediately and order urgent brain magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI). Reduce blood pressure with intravenous nitroprusside until systolic blood pressure is below 130 mmHg before considering thrombolytic therapy. Initiate therapeutic intravenous unfractionated heparin with a targeted activated partial thromboplastin time (aPTT) of 1.5–2.5 times control.

Correct Answer:

Initiate intravenous thrombolysis with recombinant tissue plasminogen activator (Alteplase 0.9 mg/kg or Tenecteplase 0.25 mg/kg) without waiting for further imaging.

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