04-29-2009, 08:36 AM
A 71-year-old man presents to the emergency department at the instruction of his primary care physician. The patient felt well when he went to bed at midnight but awoke at 8:00 a.m. with left upper-extremity weakness and numbness. He called his physician who told him to go to the emergency department. He arrives at the emergency department at 9:00 a.m.
The patient's medical history includes hypertension and hyperlipidemia for which he takes a thiazide diuretic and a statin. His blood pressure is 178/92 mm Hg; physical examination reveals mild left-sided neglect, a mild left central facial palsy, mild left upper- and lower-extremity weakness, and a mild left hemisensory deficit. Complete blood count and serum electrolytes and glucose are normal. CT scan of the brain is normal.
Which of the following is the most appropriate next step in this patient's management?
A Start aspirin
B Start intravenous heparin
C Start clopidogrel
D Start intravenous tissue plasminogen activator
E Lower blood pressure to 140/90 mm Hg
The patient's medical history includes hypertension and hyperlipidemia for which he takes a thiazide diuretic and a statin. His blood pressure is 178/92 mm Hg; physical examination reveals mild left-sided neglect, a mild left central facial palsy, mild left upper- and lower-extremity weakness, and a mild left hemisensory deficit. Complete blood count and serum electrolytes and glucose are normal. CT scan of the brain is normal.
Which of the following is the most appropriate next step in this patient's management?
A Start aspirin
B Start intravenous heparin
C Start clopidogrel
D Start intravenous tissue plasminogen activator
E Lower blood pressure to 140/90 mm Hg
