30th April 2024

An 88-year-old man is referred by the GP

An 88-year-old man is referred by the GP to the acute medical unit after a telephone consultation with his wife. She had reported that he was more confused and lethargic since this morning. On arrival, his wife informs you that he woke up as normal this morning, however whilst eating breakfast 4 hours ago he developed ‘confusion’. She reports he struggled to get his words out, dropped his spoon and started to neglect the use of his left arm. He also had a left sided facial droop. He is normally able to mobilise around the house with the aid of a stick but doesn’t tend to leave the house unless his daughter takes him out. He has a stairlift at home. His RR is 20, saturations are 95% on air, HR is 90, BP is 189/120.

On examination, he does indeed have a left sided facial droop, neglect and hemiparesis on the left side. He also has an element of dysphasia. A CT head confirms middle cerebral artery occlusion on the right.

What is the most appropriate initial management strategy?

Select the SINGLE most appropriate option from the list below. Select ONE option only.