Step 2

Neurology 2

An 88-year-old man is brought to the emergency department for slurred speech, altered level of consciousness, and left sided facial droop. The family reports that the patient was fine last night, but they noticed changes in behavior when he awoke in the morning. They thought that he might get better on his own, but then they noticed the slurred speech and facial droop. In the emergency department, the patient has a National Institute of Health Stroke Scale (NIHSS) score of 5. CT scan is ordered and is read as normal. Neurology consultation is obtained, and an ischemic stroke is suspected. The neurologist does not recommend giving tissue plasminogen factor (tPA).

Which of the following provides the best reason why tPA should NOT be given to this patient?

  • A) Giving tPA is not indicated in patients with a normal CT scan
  • B) Giving tPA outside of the 4.5 hour time window can cause reperfusion hemorrhage
  • C) Giving tPA outside of the 4.5 hour time window will not be effective in dissolving the clot
  • D) Giving tPA outside of the 4.5 hour time window will not be effective in salvaging neurons inside the core region of ischemia
  • E) Giving tPA to an 88-year-old man is contraindicated due to age

Authors

Bryce Owen

Editor

Dr. Ted O'Connell

Last updated

Sep 08, 2022

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