A 67-year-old woman with a hx of TIIDM and
afib presents with R body weakness and slurred speech. Sudden onset while she brushing her teeth 1 h ago. No word-finding difficulties, dysesthesia, headache. She is taking warfarin. PE findings incl. BP 205/90 + irregularly irregular heart beat. There is left side neglect with slurred speech. There is a corticospinal pattern of weakness of the right body, with the face and upper extremity worse than the lower extremity. INR is 1.8.
Which of the following should be done next?
a. Administer tissue plasminogen activator
b. Call a vascular surgery consult for possible endarterectomy
c. Order a brain CT
d. Order a cerebral angiogram
e. Start heparin