Cas 05 — NIHSS bas, occlusion en tandem

Vignette fictive conservée du cas source. Les actes rapportés décrivent le scénario ; ils ne constituent pas une recommandation.

I have a 55-year-old male in ED, onset of mild left arm weakness and slurred speech 2 hours ago. Fully independent baseline, mRS 0. NIHSS is low, only 5, but CTA shows a complex lesion: there is a proximal right internal carotid artery occlusion at the bulb, and also a distal right M1 occlusion. Non-contrast CT is normal with an ASPECT score of 10. We have initiated intravenous thrombolysis given the early timeframe, and the infusion is running now. He has no medical contraindications. The concern is the tandem nature of the block despite the low clinical score.