A 50 years old male patient came to emergency with right hemiparesis and loss of speech for 2.5 hours. BP is 180/100. What is the next best step in the management of this patient?
. Noncontrast head CT (NCCT) is the standard radiologic test for patients presenting with acute stroke. Early ischemic changes (EIC) are often overlooked on initial NCCT. We determine the sensitivity and specificity of improved EIC detection by a standardized method of image evaluation (Stroke Windows). Methods. We performed a retrospective cha review to identify patients with acute ischemic stroke who had NCCT at presentation. EIC was defined by the presence of hyperdense MCA/basilar aery sign; sulcal effacement; basal ganglia/subcoical hypodensity; and loss of coical gray-white differentiation. NCCT was reviewed with standard window settings and with specialized Stroke Windows. Specific features relevant to stroke assessment include hyperdense middle cerebral aery (MCA)/basilar signs, focal parenchymal hypoattenuation (notably of the insular ribbon or lenticular nuclei for MCA infarcts), and cerebral swelling manifested by sulcal or ventricular effacement or loss of coical grey-white differentiation . Decreases in CT attenuation accompanying early stroke are small; therefore, their conspicuity may be increased by using narrow window settings centered at approximately the mean attenuation in HUs of gray and white matter. We believe that the increase in lesion conspicuity achieved with this method can improve the accuracy of nonenhanced CT stroke detection . In most academic stroke centers, on-call residents, radiologists, and ED physicians are the first providers to interpret NCCT in the setting of suspected acute ischemic stroke. We hypothesize that detection of EIC can be improved by a standardized method of image evaluation that can be implemented by the treating physicians Ref Harrison20th edition pg 2234
Give antitypeensive to control BP
Aspirin 300 mg and anticogulants
Administer t-plasinogen activator
Go for NCCT
C.N.S