BOF: 15
A 72 year old male presents with a history of sudden onset weakness of the
right side of his body of 6 hours duration. He has not seen his general
practitioner for years and is not on any medication. He smokes 10 cigarettes a
day and consumes 20 units of alcohol per week.
On examination you note a right sided weakness involving his face arm and
legs. The limbs are flaccid on that side and reflexes are absent. BP 190/120,
examination of the optic fundus reveals thickening of the arteries and
arteriovenous nipping.
A CT scan of his head does not show a haemorrhage.
In this patient your next line of management would be:
a) Alteplase
b) Amlodipine
c) Aspirin
d) Clopidrogel
e) Warfarin
Answer: c)
The patient has an ischemic stroke for 6 hours. It is too late for
thrombolysis and treatment would be with aspirin and dipyridamole. Clopidrogel
would be used in those who are aspirin intolerant.
Antihypertensives are used after 72 hours unless there is hypertensive end
organ damage. Grade II retinopathy on examination of the fundus would be
against this.
Revision Tip
Revise stroke
KEYS
to SUCCESS in Medicine
page 435-441
