A fictional 66-year-old wakes with aphasia and right-sided weakness. They were last known well eight hours earlier, have disabling deficits and are not taking anticoagulants.
Listen for the assumption.
Because the exact onset exceeds the usual thrombolysis window, I thought reperfusion was no longer possible.
Which treatment decision still depends on vascular and tissue imaging?
Thrombectomy may remain possible in selected patients up to 24 hours from last known well, so the stroke pathway and appropriate imaging must continue urgently.
Choose an answer below and reveal the reasoning to see consultant feedback at every checkpoint. The full consultant-led synthesis follows after all three decisions.
Go to the first decision ↓The picture develops.
- Non-contrast CT shows no intracranial haemorrhage
- CTA shows proximal anterior-circulation occlusion
- Perfusion imaging suggests salvageable brain tissue and a limited core
Commit before you reveal.
After you select an option, reveal the model reasoning and the consultant’s feedback.
Hear the senior team refine the plan.
The registrar tests the plan, the consultant synthesises the key principle, and the SHO confirms the safer next steps.
We should confirm glucose, blood pressure, baseline function, bleeding risks and mimics without delaying the stroke pathway.
Exactly. Unknown onset changes the selection process; it does not justify abandoning time-critical assessment.
I will communicate last known well, discovery, deficit severity, imaging sequence and specialist decision status.
What must remain explicit.
- Use the current regional stroke pathway.
- Record last-known-well and discovery times separately.
- Do not delay transfer or thrombectomy discussion for non-essential tests.
Where reasoning fails.
- Treating wake-up time as onset time
- Stopping after a non-contrast CT
- Assuming every extended-window occlusion is automatically eligible
Acute disabling stroke: last known well [time], discovered [time], deficit [summary], baseline [summary], anticoagulation/glucose/BP [details], imaging [findings] and thrombectomy discussion [status].
How would you prevent an uncertain timeline from becoming an inaccurate fixed time during successive handovers?