Pre-Quiz: Acute Ischemic Stroke Pharmacotherapy

A 69-year-old female presents to the emergency department with sudden onset of right-sided weakness and difficulty in speaking. An evaluation reveals she is having an acute ischemic stroke. According to the current guidelines from the American Heart Association/American Stroke Association, which of the following are the maximum systolic and diastolic blood pressure values that will still allow for tissue plasminogen activator (tPA) administration?

Mr. DS, a 78-year-old patient with a known history of diabetes, presents to the emergency department one hour after experiencing an Acute Ischemic Stroke (AIS). He was managed on Intravenous alteplase. However, following administration of this treatment, you observe a deterioration in his neurological status. A CT scan subsequently reveals he has suffered an intracranial hemorrhage. In this pressing scenario and given the unavailability of cryoprecipitates, which intervention should you consider next in the management of this patient?

A 72-year-old female presents to the emergency department (ED) at 10 am with a significant left-sided weakness and aphasia. Her daughter last saw her well when they spoke the previous evening around 6 pm. Examination of the patient confirms severe weakness in the left arm and leg, with notable left homonymous hemianopia and aphasia. Her ECG report shows atrial fibrillation. A CT head scan confirms a large thrombus in the right middle cerebral artery.

Optimally, which of these interventions should the medical team consider first for this patient?

A 65-year-old man with a past medical history of diabetes and atrial fibrillation arrives at the emergency department showing sudden-onset altered mental state. His wife, who last observed him behaving normally an hour ago, reports his confusion, slurred speech, and muscle weakness after dropping his cup of coffee. The man presents with an inability to answer queries, facial drooping on his left side, and an inability to comply with commands. His temperature is 98.0°F (36.7°C), blood pressure is 150/90 mmHg, pulse is 115/min, and respirations are 17/min. It’s noticeable that he is unable to move his right upper extremity. He is currently on warfarin, however, the specifics of his other medications are unclear. His abrupt onset confusion, asymmetrical smile, and weakness combined with risk factors like atrial fibrillation, diabetes, and hypertension suggest signs of stroke. Beyond further physical examinations, what should be the most suitable next step in management?

A 63-year-old female patient with a past medical history of hypertension and hyperlipidemia arrives to the emergency department displaying symptoms of acute weakness on her right side, slurred speech, and sudden vision loss. Upon evaluation using the NIH Stroke Scale, her total score is 23. Based on this NIHSS score, which category of stroke severity best describes her condition?