A 70-year-old male presents with acute right-sided hemiparesis and expressive aphasia starting 75 minutes prior to arrival. Non-contrast CT of the brain demonstrates no intracranial hemorrhage. Blood pressure is 160/95 mmHg, and blood glucose is 130 mg/dL. What is the most appropriate immediate intervention?

Answer and explanation

Correct answer: A. Administer intravenous tissue plasminogen activator (IV rtPA / alteplase)

  1. Step 1: Confirm clinical stroke timeline: Onset of acute ischemic stroke within the 4.5-hour therapeutic window (here, 75 minutes).
  2. Step 2: Verify contraindications: Non-contrast CT excludes intracranial hemorrhage, and blood pressure is below the 185/110 mmHg threshold.
  3. Step 3: Determine first-line therapy: Intravenous thrombolysis with recombinant tissue plasminogen activator (rtPA) improves neurological outcomes when administered within 4.5 hours of symptom onset.
Answer
Administer intravenous tissue plasminogen activator (IV rtPA / alteplase).
Why not the others: 'Aspirin with deferred thrombolysis' wastes the 4.5 hour window; 'heparin infusion' does not lyse an acute thrombus and adds bleeding risk; 'hemicraniectomy' is for malignant edema days later, not first-hour therapy.

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