رجل عمره ٦٧ سنة عنده سكتة إقفارية، بدأ مذيب الجلطة الوريدي قبل ساعتين، وكان يتحسن. فجأة صار عنده صداع شديد وقيء، وتدهور الوعي، وارتفع الضغط إلى ١٩٦/١٠٤. ما أول إجراء؟

A 67-year-old man with ischaemic stroke started IV thrombolysis two hours ago and was improving. Suddenly he develops severe headache and vomiting, his consciousness deteriorates and BP rises to 196/104. What is the first action?

1. Raise the legs and give a rapid fluid bolus
2. Stop the thrombolytic and notify the physician
3. Give analgesia and an antiemetic, then observe
4. Give aspirin to prevent a new clot

Answer: B) Stop the thrombolytic and notify the physician. Neurological deterioration, headache and vomiting after thrombolysis may mean haemorrhage. Stop the infusion, notify the physician and prepare for urgent imaging and reversal. Frequent neuro checks follow thrombolysis.