Question: Hello,

I am trying to get some second opinion for my father's ischemic stroke. He (64 years) suffered the stroke on 10 days ago. Lost control over his right hand, leg and speech. He was administered the clot removal injection (tPA?) after around 2 hrs 45 mins. Soon after that he regained control over his right leg and right arm. But continued to struggle gripping anything in his right fist and struggled to speak. He spoke his first words 3 days after the stroke. He was discharged from the hospital with the following medications (until further review):

1) Eliquis (Apixaban)
2) Ecospirin (Aspirin)
3) Telmisartan
4) Strocit (Citicoline)
5) Rosuvastatin

He is currently doing speech therapy and physio therapy for this right hand strength. Right hand is improving well, he was able to write with it yesterday. Speech though is improving at a slow pace. Majority of his talk is garbled words and slurred speech. But compared to a week back he can pronounce and say many words and phrases.

Some historical context:
1) He had suffered a heart attack in the year 2001 and had angioplasty performed on him. He had been taking Aspirin medication since then.

2) In May of 2019 he had transient ischemic attack which laster for around 30 seconds. He lost speech during that process. But got it back right away. Back then too he got MRI and Carotid Doppler done. All the reports came back normal. So the doctor only increased his aspirin dosage and he went back to normal day today life.


Now here are my main questions:
1) Based on the attached reports , is the above treatment with medications the right one (Basically I need a second Neurologist's opinion on this. I trust our current Neurologist completely, but just for our peace of mind want a second opinion on this).

2) My main concern is about his speech recovery. Based on the CT or the MRI does it indicate any extensive damage to the language center in his brain? What should be the realistic expectations with respect to his speech coming back? Is regular speech therapy along with in home efforts by the family to get him to talk the right approach? Is there any other treatment that you would recommend.

I am attaching the MRI and CT scans done before and after the tPA injection and the discharge summary. If there is anything missing, please let me know. I can try to get that.

Thanks,

Kartik

Hi, I have provided some attachments. Please review them.

Hi, I have provided some attachments. Please review them.

Thanks for your response Dr XXXXXXX

Regarding Apixaban, the Neurologist suspected the clot might have come from the heart. I have attached the holter report which showed one incident of Ventricular tachycardia in the 24 hr window. But no Atrial Fibrillation. The cardiologist too felt it was ok to give apixaban.

With respect to your concern with the drug, do you feel its not adequate to stop future clots, due to absence of Atrial Fibrillation, or do you think its an overkill? Sorry for my ignorance, but if you could explain what your concern with Apixaban is?

Thanks,

Kartik

I had previously posted the above question along with the Holter report. Somehow it never got posted on the thread.