For a suspected code stroke, what imaging should be obtained before thrombolysis?

For a suspected code stroke, what imaging should be obtained before thrombolysis?

• A. Non-contrast CT head to exclude intracranial hemorrhage
• B. MRI brain
• C. CT angiography
• D. No imaging

Answer: (A)

The key safety step before giving IV thrombolysis is to quickly rule out intracranial bleeding with a non-contrast CT scan of the head. This test is fast, widely available, and can show an acute hemorrhage, which would make thrombolysis dangerous or contraindicated. Because time is critical in stroke care, a non-contrast CT’s speed allows rapid decision-making to treat ischemia if there’s no bleed. MRI, while more sensitive for early ischemia, usually takes longer and isn’t as practical in the hyperacute setting. CT angiography can identify a large vessel occlusion and help plan endovascular therapy, but it isn’t required to be completed before initiating IV thrombolysis and would add time in many situations. Imaging nothing before treatment would risk missing a bleed and could lead to catastrophic hemorrhagic transformation after thrombolysis.

The key safety step before giving IV thrombolysis is to quickly rule out intracranial bleeding with a non-contrast CT scan of the head. This test is fast, widely available, and can show an acute hemorrhage, which would make thrombolysis dangerous or contraindicated. Because time is critical in stroke care, a non-contrast CT’s speed allows rapid decision-making to treat ischemia if there’s no bleed.

MRI, while more sensitive for early ischemia, usually takes longer and isn’t as practical in the hyperacute setting. CT angiography can identify a large vessel occlusion and help plan endovascular therapy, but it isn’t required to be completed before initiating IV thrombolysis and would add time in many situations. Imaging nothing before treatment would risk missing a bleed and could lead to catastrophic hemorrhagic transformation after thrombolysis.