A 72-year-old female presents with acute right-sided hemiparesis and aphasia starting 90 minutes ago. Non-contrast brain CT excludes intracranial hemorrhage. Blood pressure is 165/95 mmHg, and blood glucose is 135 mg/dL. What is the most appropriate immediate intervention?

Answer and explanation

Correct answer: A. Intravenous recombinant tissue plasminogen activator (rtPA)

  1. Step 1: In acute ischemic stroke presenting within 4.5 hours of symptom onset with no contraindications on non-contrast head CT and blood pressure < 185/110 mmHg, intravenous thrombolysis with recombinant tissue plasminogen activator (rtPA / alteplase) is the treatment of choice to restore cerebral perfusion and improve functional outcomes.
Answer
Intravenous recombinant tissue plasminogen activator (rtPA).
Why not the others: 'Intravenous heparin infusion' is contraindicated in acute stroke due to significant risk of fatal intracerebral hemorrhage; 'Oral aspirin 300 mg alone' is given after 24 hours if rtPA is administered; 'Sublingual nifedipine' causes precipitous blood pressure drops leading to ischemic stroke extension.

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