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Neurology


Answer 3
  1. Rapidly resolving symptoms. Rapidly resolving symptoms are suggestive of transient ischemic attack, and therefore the use of rt-PA is generally deferred. As there is no absolute NIHSS score threshold for the use of rt-PA, clinical judgment is used to weigh risks and benefits of administering rt-PA. A NIHSS score of 3 is not an absolute contraindication to using rt-PA. It could represent a patient with severe aphasia and mild arm weakness (a significantly disabling condition) or a patient with minor facial droop, mild dysmetria of the nondominant arm, and sensory inattention (a minimally disabling condition). Although blood pressure should generally be managed to stay below 185/110 mm Hg, an initial untreated blood pressure over 185/110 mm Hg is not a contraindication to rt-PA therapy. Although recent use of antiplatelet medications may increase the risk of hemorrhage, rt-PA can be given concomitantly. Recent minor surgery, especially at a compressible site, is not a contraindication to rt-PA therapy.

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