MRCP2-3401

MRCP2-3401

A 65-year-old male arrives at the emergency department via blue light ambulance 90 minutes after experiencing sudden onset right-sided weakness and expressive and receptive dysphasia. He has a medical history of T2DM, hypertension on 3 agents, and a 40 pack year smoking history. Upon examination, he exhibits a dense 0 out of 5 right hemiparesis and complete expressive and receptive dysphasia, confirmed by collateral history from his wife. The patient scores an NIHSS score of 7 and has no recent surgery or head trauma, nor is he on an anticoagulant or has a history of coagulation disorders. A CT head reveals no areas of hemorrhage but a likely evolving area of ischemia in the left middle cerebral artery territory, with an ASPECT score of 8. Upon arrival, his vital signs are as follows: temperature 36.7 degrees, heart rate 90/min and regular, blood pressure 220/150 mmHg, sats 99% on air, respiratory rate 20/min. What is the most appropriate first-line treatment?