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Answer 2
  1. Aspirin 325 mg. The primary goal of using CT of the head for evaluation of acute stroke is to exclude hemorrhage as the etiology. CT of the head has low sensitivity (approximately 50%) within the first 12 hours of onset of ischemic stroke.1 Antiplatelet agents (eg, aspirin) are the standard treatment for ischemic stroke. Use of anticoagulant agents, such as heparin and warfarin, is restricted to cases of stroke due to cardioembolism (atrial fibrillation, prosthetic valves, ischemic cardiomyopathy), for which the evidence has shown a favorable risk-benefit outcome. There are no clear indicators of such a process in this case. Use of IV thrombolytic agents, such as alteplase (a tissue plasminogen activator), is restricted to within 3 hours of symptom onset.2 Risk for hemorrhagic complications outweighs expected benefit in this patient (earliest possible treatment would be at 4.5 hr after symptom onset).

    1. Mullins ME, Schaefer PW, Sorensen AG, et al. CT and conventional and diffusion-weighted MR imaging in acute stroke: study in 691 patients at presentation to the emergency department. Radiology 2002;224:353-60.

    2. Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. N Engl J Med 1995;333:1581-8.

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