Brief Answer:
The mangement of stroke revolves around adequate blood flow to the Brain.

Detailed Answer:
Hell there! Thanks for coming to HealthCareMagic.

I am so sorry to hear about your fathers condition. A stroke is a devastating blow to any family and maintain calm while we try to address the issue step by step is important.

Though a stroke hits suddenly.. the recovery, such as it is, is a slow process.

Let us first understand what parts of your fathers brain have been affected and what this means.

The MRI you have mentioned shows firstly that this is NOT his first stroke. He had an old right cerebellar ICH... The recent stroke is the one affecting the MCA and PCA territories on the left side of the brain. This could possibly be the cause, of his hemiplegia.. but the data does not fit very well here. In a new Left sided MCA stroke (infarct), I would expect the RIGHT side of his body to be paralyzed. Not the left.

Could you do me a favor an upload the entire MRI report so that I can take a look at it. It would be great if you could, the more information you give me, the more useful I can be to you and your father.

Now that we know that the stroke has injured the brain in these regions, we need to think along two main lines

1) Preventing another stroke
2) Trying to rehabilitate the regions of the brain that have been affected.

1) When it comes to prevention.. the 2 most important things that have to be looked into are your fathers blood pressure trends and the health of his arteries.
If his blood pressure is uncontrollably high or even trending high for many years... that will damage the arteries that supply blood to the brain and lead to strokes quite frequently. I see he is on amlodipine. The doctors at the hospital now have to see the trends over the next few days and see if this drug is adequate or others have to be added.

His blood vessels are most likely already damaged to some degree. This leads to the clotting of blood on their inside walls and can lead to strokes as well. To prevent this clotting, he is being put on Ecosprin. I would ask that you discuss the use of another medication called Clopidogrel in his case as well. It may help keep him safe from further strokes. It also prevents clot formation.

I would strongly suggest that an Ultrasound scan of his Carotid and Vertebral Arteries be done when he is stable. If the scan shows very badly damaged vessels.. then he may need surgery to clean them out or bypass them.

2) Rehabilitation. In the immediate period after a stroke.. the most important thing to do is maintain adequate blood flow to the brain and prevent it from swelling. To do this.. typically the patient is kept under observation in an Intensive Care Unit and given medications which either raise the BP or lower the BP as needed. At the same time.. they are normally given diuretics like Mannitol and anti seizure medications like Levitiracetam or Phenytoin to reduce the swelling in the brain.

After that, it's up to the patient to heal on their own.. the brain must be given time and support to repair or rewire its own neural pathways and create new ones as replacement. This is a long and slow affair and you can see great improvement in a persons status after a stroke for as long as 48 months.

To help this process along.. Physical therapy and speech therapy are INCREDIBLY important.

You must remember though. Sometimes.. the brain isn't able to heal itself. The swelling gets to bad.. another stroke occurs or seizures occur and the patient may worsen and pass away. Its a possibility and the supportive care in the ICU is the only thing that can address this. It doesn't always work though and you have to discuss with the Neurologists how things are progressing every 12 hours or so.

I hope this information gives you a basic idea of what is going on with your father. I hope he does well. Let me know how I can help you and please upload that MRI report or the scan itself. I will try and help more.

Vinay

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