Stroke treatment



A 77-year-old woman is admitted to hospital with a urinary tract infection. She receives antibiotics and seems to be responding well. On the fourth day she is eating her lunch when she suddenly drops her fork. She calls for the nurse who notices the left side of her face is drooping. What is the best next course of action?


A. CT head

B. Thrombolysis

C. MRI head

D. Aspirin

E. Place nil by mouth



(E) This patient has suffered a stroke. This is a medical emergency. As she is within the 3-hour window for thrombolysis (B), she must be assessed immediately. However, thrombolysis is only useful in ischaemic stroke and can severely worsen haemorrhagic stroke. It is impossible to clinically tell the difference with certainty; she therefore warrants urgent imaging. Haemorrhages are much easier to detect on CT (A) as blood shows up white (hyperdense), plus there is easier access to CT unlike MRI (C) which is not always available. If thrombolysis is contraindicated, 300 mg of aspirin (D) is given in the case of ischaemic stroke. Option (E), however, is the most appropriate next step as removing her lunch is a quick, simple intervention that may prevent the complication of aspiration pneumonia. The nurse can then call the doctors or put out a thrombolysis call.

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