Approach to increased intracranial pressure Quiz: Ace Your Exams

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A 62-year-old man is brought to the emergency department for evaluation of right arm weakness. The symptoms were present when the patient awoke, accompanied by drooling and a right facial droop. When attempting to rise from bed, the patient collapsed and has been difficult to arouse since. Medical history includes type 2 diabetes mellitus, hypertension, and hyperlipidemia. Current medications are metformin, lisinopril, and simvastatin. Temperature is 37.0°C (98.6°F), pulse is 52/min, respirations are 8-10/min and irregular, and blood pressure is 188/95 mmHg. Glasgow Coma Scale (GCS) score is 7. The patient opens his eyes and withdraws the left extremities to pain but has no verbal response. There is flaccid paralysis on the right side. Which of the following is the most appropriate next step in management?

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Intubation

Computerized tomography (CT) of the head without contrast

Magnetic resonance imaging (MRI) of the brain without contrast

Intravenous tissue plasminogen activator (tPA)

Flatten the head of the bed