A 50-year-old male presents to the triage desk with sudden-onset unilateral facial droop, right-sided arm drift, and slurred speech that began 45 minutes ago. What is the immediate priority diagnostic neuroimaging required before considering intravenous thrombolysis (Alteplase / Tenecteplase)?

Answer and explanation

Correct answer: B. Non-contrast Head Computed Tomography (CT) to exclude intracranial hemorrhage

  1. Step 1: In suspected acute ischemic stroke within the thrombolytic window (<= 4.5 hours from symptom onset), the immediate, emergent diagnostic step is a non-contrast brain CT.
  2. Step 2: The essential objective is rapidly and definitively excluding acute intracranial hemorrhage, which is an absolute contraindication to fibrinolytic therapy.
Answer
Non-contrast Head Computed Tomography (CT) to exclude intracranial hemorrhage.
Why not the others: 'Functional Brain MRI with spectroscopy' takes excessive time and is unnecessary for acute thrombolysis decisions; 'Digital subtraction catheter angiogram' is an invasive procedure reserved for thrombectomy, not initial screening; 'EEG' is secondary and should not delay reperfusion therapy.

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