New focal weakness

73-year-old woman from IL, normally ambulatory with cane, reports sudden left-arm weakness and difficulty speaking noticed at 1420. Last known well 1405. Denies trauma or seizure. Takes apixaban.

Primary survey intact. Patient found seated in dining room with staff. GCS 14, left facial droop, arm drift and dysarthria; BGL measured. Serial vitals obtained and stroke screen remained positive.

Differential considerations: 1) acute stroke, 2) intracranial hemorrhage, 3) metabolic stroke mimic. Time-sensitive focal neurologic deficit.

Stroke pathway activated. Airway, glucose, rhythm and neurologic status monitored without avoidable delay. Transported priority to designated stroke centre with pre-alert; last-known-well, anticoagulant use and serial findings transferred.