Question

an elderly patient is brought to the emergency department after being found on the floor after a fall. the patient has unilateral sagging of the face, marked slurring of the speech, and paralysis on one side of the body. the patients blood pressure is 220/190 mm hg. what is the likely treatment for this patient?
carotid endarterectomy
close observation until symptoms resolve
neurosurgical consultation
thrombolytic therapy

Explanation:

The patient presents with symptoms (unilateral facial sagging, slurred speech, unilateral body paralysis, and extremely high blood pressure - 220/190 mmHg) that are highly suggestive of a hemorrhagic stroke. Carotid endarterectomy is for carotid artery stenosis (usually for ischemic stroke risk reduction when there is significant stenosis). Close observation until symptoms resolve is not appropriate as the patient has severe symptoms and very high blood pressure which likely requires urgent intervention. Thrombolytic therapy is contraindicated in hemorrhagic stroke as it can worsen bleeding. Neurosurgical consultation is needed to evaluate for possible surgical intervention (like evacuation of hematoma if indicated) in case of hemorrhagic stroke.

Answer:

Neurosurgical consultation