What must be ruled out on CT imaging before administering IV alteplase?

What must be ruled out on CT imaging before administering IV alteplase?

• A. Intracranial hemorrhage
• B. Brain tumor
• C. Subarachnoid hemorrhage
• D. Cerebral aneurysm

Answer: (A)

When treating an acute ischemic stroke with IV alteplase, the first imaging step is to exclude any intracranial bleeding. Alteplase dissolves clots, so if there is bleeding inside the skull, giving a thrombolytic would let the bleed worsen and can be life-threatening. A non-contrast CT is checked immediately because it quickly reveals intracranial hemorrhage. If the scan shows no bleed (and there are no other contraindications), administering alteplase is considered safe. Brain tumors or cerebral aneurysms by themselves do not automatically rule out thrombolysis; they are not the immediate gating finding unless they are associated with a bleed. Subarachnoid hemorrhage is a type of intracranial bleed, so its presence would also prevent thrombolysis. The critical point is the absence of intracranial hemorrhage on imaging before giving alteplase.

When treating an acute ischemic stroke with IV alteplase, the first imaging step is to exclude any intracranial bleeding. Alteplase dissolves clots, so if there is bleeding inside the skull, giving a thrombolytic would let the bleed worsen and can be life-threatening. A non-contrast CT is checked immediately because it quickly reveals intracranial hemorrhage. If the scan shows no bleed (and there are no other contraindications), administering alteplase is considered safe.

Brain tumors or cerebral aneurysms by themselves do not automatically rule out thrombolysis; they are not the immediate gating finding unless they are associated with a bleed. Subarachnoid hemorrhage is a type of intracranial bleed, so its presence would also prevent thrombolysis. The critical point is the absence of intracranial hemorrhage on imaging before giving alteplase.