A 68 year old male develops acute onset left facial droop, left arm and leg weakness whilst eating his breakfast at 7am. No LOC, syncope or seizure activity.

He is previously fit and well and lives alone in a bungalow since his wife passed away. He is independent of all ADL's. His daughter lives in the same village and helps him with his shopping and cleaning. He has a 50 pack year history of smoking and drinks minimal alcohol. He calls his daughter who promptly calls an ambulance for him.

On Examination

  • PMH - Hypertension and diabetes.

  • DH - Metformin 1g bd, amlodipine 5md od.

  • In the ambulance he is noted to have a BP 200/110 but no speech disturbance or visual field defects. He arrives into Resus at 8.20am.


Answer one question before attending the face-to-face teaching session. Add comments to answers already given if you think it's appropriate. The first part of teaching will be spent discussing this case:

  1. What protocol can you use for this patient and what would be your initial management?

  2. What is the ROSIER score, what is it's significance and what score would this patient have?

  3. Is this patient eligible for thrombolysis and if so why?

  4. What are the criteria and contraindications for acute thrombolysis in stroke?

  5. What are the UHL guidelines with regard to hypertension in acute stroke?

  6. What would your management of a suspected haemorrhage post thrombolysis be?

    When he arrives to the ED his symptoms have fully resolved. The symptoms lasted for 45 minutes. He has no previous similar episode. His BP on arrival is 160/85.

  7. What will your management be for this patient now and justify your answer.