A 63-year-old man with sudden left-sided weakness and trouble speaking after waking from a nap. Which additional finding is most likely to determine how quickly he should be transferred to the emergency department?

• A. Time since onset
• B. Last known normal state
• C. Blood pressure on arrival
• D. Glucose level

Answer: (B)

The most important concept here is that the timing of stroke treatment hinges on knowing when symptoms began. In someone who woke up with stroke symptoms, the exact onset time is unknown. The key piece of information to guide rapid ED transfer and initial treatment decisions is the last time the patient was known to be without deficits. That “last known normal” time helps estimate whether the patient falls within the window for reperfusion therapies and directs how aggressively imaging and thrombolysis decisions should be pursued.

While checks like blood pressure and glucose are essential for safe management in the ED, they do not determine the urgency of arrival as directly as the last known normal time. Blood glucose helps rule out other causes of symptoms, and blood pressure must be managed carefully for treatment eligibility, but neither defines the onset window the way last known normal does.