Medical history 60 year-old male patient, admitted to the ER in a state of drowsiness and presented right sided hemiplegia and central facial paralisis. He was aphasic and his GCS score was 10. Was found unconscious at home, by family members, who were unable to determine precisely the time of the onset of symptoms. Positive history of coronary artery disease, heavy smoking (40 pack-years) and bipolar disorder. A computed tomography (CT scan) of the head without iodine contrast was ordered. Image 1: Computerized tomography of the brain - without intravenous contrastImage 2: Computerized tomography of the brain - without intravenous contrastImage 3: Computerized tomography of the brain - without intravenous contrastImage 4: Computerized tomography of the brain - without intravenous contrast Question:What is the most likely diagnosis and the best course of action considering this case and the images provided? Acute ischemic stroke (AIS) – Admission to the intensive care unit and administration of r-tPa for thrombolysis Transient ischemic attack (TIA) – Observation in the ER and wait for the spontaneous resolution of neurologic deficits Acute ischemic stroke (AIS) – Admission to the intensive care unit and perform serial neurologic examinations Acute hemorrhagic stroke (AHS) – Refer to neurosurgery for immediate aspiration of the cloth and control of the bleeding Time is Up! Time's up
