Angela is a 65 year old lady who was previously healthy and well. She presented with a right sided facial and upper and lower limb weakness and right homonymous hemianopia. Her blood pressure is 160/90. The CT scan results are below. No contraindications have been identified. Time of onset of symptoms was 7.40am, it is now 9am.
There is some swelling, loss of distinction between grey and white matter so that the basal ganglia and cortex are no longer visible. Confusingly grey matter (i.e. parts of the brain where the cell bodies and nuclei of the neurones are) appears whiter on CT scans than grey matter (i.e. the brain tissue made up of the fibres connecting neurones together).
Ischaemic changes occur as a result of a blockage of the blood flow to an area of the brain, which causes brain cells in the area to die.
What does the CTA show?
There is no evidence of a large artery occlusion or other abnormality of the extracranial or intracranial vessels.
Select the correct answer below about Angela’s treatment:
Which treatment(s) is Angela likely to benefit from?
No hyper acute treatment – Wrong – Angela has a severe stroke, only early changes on a CT scan and is within 4.5 hours of onset. She is likely to benefit from thrombolysis.
Just immediate aspirin – Wrong – Angela has a severe stroke, only early changes on a CT scan and is within 4.5 hours of onset. She is likely to benefit from thrombolysis. Aspirin would be appropriate if thrombolysis were not used.
Just thrombolysis – Correct – Angela has a severe stroke, only early changes on a CT scan and is within 4.5 hours of onset. She is likely to benefit from thrombolysis.
Immediate aspirin and thrombolysis – Wrong – Angela has a severe stroke, only early changes on a CT scan and is within 4.5 hours of onset. She is likely to benefit from thrombolysis. Aspirin should be withheld for 24 hours after thrombolysis
Just thrombectomy – Wrong – Angela is likely to benefit from thrombolysis, but not thrombectomy because she does not have a large artery blocked on CTA
Thrombolysis and thrombectomy – Wrong – Angela is likely to benefit from thrombolysis, but not thrombectomy because she does not have a large artery blocked on CTA
