A 64-year-old male presents to the ED with the acute onset of profound right-sided motor weakness and expressive aphasia. The patient has no headache, no history of trauma, and no other problems upon presentation. His only chronic medical problem is hypertension that is well controlled on his medications. His wife witnessed the onset of his symptoms while they were eating dinner 3.5 hours prior to arrival. He has normal vital signs, and a stat CT scan of the head is normal as are his laboratory studies. His deficits have persisted throughout his expedited workup and he is now 4 hours into an acute ischemic stroke (an hour beyond the FDA-approved treatment window for intravenous rt-PA), with a calculated NIHSS score of 16.
What emergent treatment options, if any, do you have for this patient?
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Last Updated on November 1, 2021