What is the first step when a patient presents with stroke symptoms?

• A. Administer anticoagulation therapy
• B. Head CT without contrast
• C. Immediate MRI
• D. Consult neurology

Answer: (B)

When a patient presents with stroke symptoms, the first critical step is to perform a head CT without contrast. This imaging technique is essential because it helps to quickly determine whether the stroke is ischemic (caused by a blockage) or hemorrhagic (caused by bleeding). Since the management of these two types of strokes is vastly different, identifying the nature of the stroke promptly can significantly impact treatment decisions and outcomes.

A head CT can be completed rapidly and is widely available in emergency settings. It can detect acute intracranial hemorrhages, enabling timely surgical interventions if necessary. In cases where an ischemic stroke is suspected and no bleeding is evident on the CT, other treatments, such as thrombolysis, can be promptly initiated.

While other options like MRI or consultation with neurology are important, they are not the fastest or most immediate steps required. MRI, for instance, provides more detailed information but takes longer to perform and interpret. Meanwhile, administering anticoagulation therapy before imaging could be harmful, particularly in cases of hemorrhagic stroke. Thus, obtaining a head CT without contrast is the most appropriate first action for a patient with stroke symptoms.