Select the crosses for each colleagues decision and rationale
Prof Mark Barber
Decision
- No BP intervention
- No lysis
- No thrombectomy
No acute stroke interventions apart from a swallow screen, aspirin, stroke unit admission and very close monitoring for early deterioration.
Rationale
A borderline case, but her deficits are very mild and would seem to be non-disabling. She is early after onset of neurological symptoms and may improve spontaneously. However, she would need watched for any deterioration occurring whilst still within the time windows for lysis. There is no LVO, so not for thrombectomy.
Dr Tracey Baird
Decision
- No BP intervention
- No lysis
- No thrombectomy
Rationale
This a mild event which may well be stroke, but has no perfusion deficit or vessel occlusion.
The evidence base for treatment of such mild strokes is mixed, and my preference may well be to offer this patient participation in a clinical trial.
I would not lyse or offer thrombectomy.
Dr Anthony Pereira
Decision
- Replace No BP intervention is needed
- Request CT
- No lysis
- No referral for thrombectomy
Rationale
This is a mild syndrome and may not turn out to be stroke.
This case would not be suitable for thrombolysis and is unlikely to be caused by a large vessel intracranial occlusion.
I would only request a CT .
If I was uncertain of the clinical diagnosis, I would request an MRI brain later in the day.
Dr Shelagh Coutts
Decision
- No BP intervention
- No lysis
- No thrombectomy
Rationale
This patient has presented with very minor deficits that are non disabling. There is no evidence of an occlusion or perfusion abnormality. I would not thrombolyse her. I would treat her with aspirin and clopidogrel as a minor stroke.
Dr William Whiteley
Decision
- No BP intervention
- No lysis
- Refer for thrombectomy
Rationale
Here we have a patient with a very mild deficit, normal CT and no apparent disabling symptoms. I am slightly swayed by the normal CTA as well.
However, if she felt that the current deficit was worth the risk of major ICH, I would consider alteplase, but this would need a careful conversation which may not be possible by telemedicine at 03:00, so my fallback would be no alteplase.
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