A patient presents with sudden-onset facial droop, leg weakness, and slurred speech. What is the most likely diagnosis and initial imaging?

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In acute stroke care, the first priority is to quickly tell apart bleeding from a clot so you can choose the right treatment. A sudden facial droop, leg weakness, and slurred speech fit an acute focal neurologic deficit caused by a stroke until proven otherwise. The best initial test is a non-contrast head CT because it can rapidly show an intracranial hemorrhage or other contraindications to thrombolysis. If the scan shows no hemorrhage and the patient is within the treatment window, stroke-directed therapies to restore blood flow can be pursued. MRI is more sensitive for detecting early ischemic changes and can help clarify ambiguous cases or assess extent, but it isn’t typically the first imaging step in the emergency setting because it takes longer and may not be immediately available.

So, the most likely diagnosis is acute ischemic stroke, with non-contrast head CT as the initial imaging to differentiate hemorrhage from ischemia.