The dose question — acute L MCA after thrombolysis
| Patient | 67M, acute phase |
|---|---|
| LesionMCA territory, moderate-severe | |
| Severity | NIHSS 12 |
| Days since onset | 2 |
| Before the strokeIndependent; retired teacher, walks the dog daily. | |
| Also on the chartAtrial fibrillation; Hypertension | |
| PrecautionsSwallow screen pending — nothing by mouth until cleared; Flaccid right shoulder — supported at all times; BP parameters per medical team | |
Test yourself
Before any upright work this morning, what comes first?
The teaching
The acute dose decision is where AVERT 2016’s lesson lands hardest: the arm of the trial that looked most like dedication — high-dose, very early — was the arm that did worse. The plan is built from the safety screens upward: swallow, sitting tolerance, then short frequent bouts measured against a balance scale the whole team can read.
- New drowsiness, worsening weakness or headache — escalate before any session
- Shoulder pain on handling — stop and reassess support
Read next
The full sequence
This page carries the case’s first decision. The full sequence — every decision, the five-domain examination, and the debrief that grades you — is in the drill, and the library is included with membership.
Sources on this page: Winstein CJ et al. Guidelines for Adult Stroke Rehabilitation and Recovery. Stroke. 2016 · AVERT Trial Collaboration group. Bernhardt J et al. Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT). Lancet. 2015 · Moore JL et al. A core set of outcome measures for adults with neurologic conditions. J Neurol Phys Ther. 2018. Blum L, Korner-Bitensky N. Phys Ther. 2008