Young People Don’t Get Strokes?

The patient arrives. He is agitated, dysarthric and has left sided hemiplegia. Time of onset is unclear as he awoke at 04:30 feeling unwell with established symptoms.

He has a history of hypertension and Nephrotic syndrome requiring permanent anticoagulation following surgery for ischaemic bowel.

What bedsides test/tests would you perform?

Although combative and difficult to assess, this patient scores highly on the ROSIER scale. His Blood Glucose is normal.

What initial imaging modality should be employed in the investigation of acute stroke?

The CT scan is reported urgently: "no acute intracranial pathology". On questioning his partner, it is clear that following a recent bereavement the patient was non-compliant with his anticoagulation therapy. At 01:00 the patient was well before going to sleep. The patient is thrombolysed and a CT angiogram is performed.

There is occlusion of the distal internal carotid artery and proximal middle cerebral artery.

Can patients receive both thrombolysis and thrombectomy?

What is the cut-off time for mechanical thrombectomy from time of stroke onset?