Arthur Pendelton, a 68-year-old retired history teacher, is brought to the emergency department by emergency medical services 75 minutes after the sudden onset of right-sided weakness and inability to speak.

According to his wife, he was in his usual state of health eating breakfast at 8:00 AM when he suddenly dropped his coffee mug, slumped to the right side of his chair, and was unable to speak or understand her questions. She immediately called emergency medical services, who noted a positive prehospital stroke screen and pre-notified the receiving hospital.

His past medical history is significant for hypertension, hyperlipidemia, and paroxysmal atrial fibrillation diagnosed 2 years ago. He was prescribed lisinopril, atorvastatin, and apixaban, but his wife reports that he stopped taking apixaban 4 months ago due to concerns about bruising. He has no history of recent surgery, trauma, intracranial hemorrhage, or gastrointestinal bleeding. He is a former smoker with a 20-pack-year history and drinks alcohol socially.

He is alert but appears distressed and is unable to follow verbal commands. He is afebrile at 36.8 °C (98.2 °F). His heart rate is 98 bpm and irregularly irregular, his blood pressure is 192/108 mmHg, and his respiratory rate is 16 breaths/min. His oxygen saturation is 96% on room air. His estimated body weight is 80 kg. He has global aphasia and NISSS is 18.