رجل عمره ٦٨ سنة جاء للطوارئ بضعف في الذراع اليمنى وصعوبة كلام بدأت قبل ساعة، وضغطه ٢٣٠/١٣٠، والنبض ٨٨، والأشعة المقطعية لم تُعمل بعد. ما التصرف الصحيح بخصوص الضغط؟

A 68-year-old man arrives with right arm weakness and speech difficulty that began an hour ago. BP 230/130, HR 88, and CT has not yet been done. What is the correct approach to his blood pressure?

1. Do not lower it rapidly before the plan is set
2. Lower it immediately to 120/80 to protect the brain
3. Ignore the pressure entirely until the next day
4. Give sublingual nifedipine straight before imaging

Answer: A) Do not lower it rapidly before the plan is set. In acute stroke the brain needs adequate pressure to perfuse threatened tissue. BP is lowered to set limits depending on stroke type and thrombolysis plans (for example below 185/110 before a thrombolytic), never abruptly.