In hyperacute ischemic stroke, what is the next step according to guidelines?

• A. Initiate antibiotics
• B. Wait for imaging results
• C. Pursue rapid evaluation for thrombolysis or thrombectomy
• D. Lower BP to 120/80 immediately

Answer: (C)

In hyperacute ischemic stroke the priority is to restore blood flow as quickly as possible, so the immediate goal is to determine whether the patient is a candidate for reperfusion therapy. Rapid assessment for thrombolysis (IV alteplase) within the approved time window and eligibility for mechanical thrombectomy (for suitable large-vessel occlusions) is the most time-sensitive next step. Imaging is performed right away to confirm ischemia and exclude hemorrhage, but delaying evaluation for reperfusion would waste crucial minutes that could worsen brain injury. Initiating antibiotics isn’t part of acute stroke management unless there’s an infection, and aggressively lowering blood pressure isn’t routine in this phase because it can reduce cerebral perfusion to still-viable brain tissue unless specific contraindications exist.