Elderly woman, non-adherent to antihypertensives, BP 218/128, sudden hemiplegia but conscious, with normal INR and platelets. This is the picture of a hypertensive stroke (most likely ICH), where the priority is IV antihypertensives (e.g. nicardipine or labetalol) to keep SBP below about 160 and limit haematoma expansion. Even in ischaemic stroke, BP is treated when diastolic is above 120.

• FFP is not needed (INR 1.1).
• Drainage/decompression is not indicated in a conversing patient.
• Observation leaves dangerous hypertension untreated.