Case 4

35 year old women, known with rheumatic heart disease (mitral stenosis), on aspirin. She presented to emergency room with sudden headache and left side weakness for 60 minutes. The neurological examination shows a conscious young woman with neglect to the left side, left homonymous hemianopia and left hemiparesis (NIHSS 13)

This is her CT Scan of the brain (click on picture to enlarge)

This is her Diffusion MRI (click on picture to enlarge)

This is her Perfusion MRI (click on picture to enlarge)

What would your best response to the case be ?

  1. The time window for thrombolysis is not appropriate.

  2. The previous use of aspirin contraindicates the use of thrombolyis.

  3. There is no mismatch between the diffusion and perfusion MRI.

  4. This is a patient that would benefit from the use of thrombolytic therapy.

  5. The diffusion and perfusion MRI would not give more information regarding potential use of thrombolytic when compared to CT.

Select your answer
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E