Brief Answer:
Read below.

Detailed Answer:
I read your question carefully and I understand the impact this condition must have caused on your family.

Regarding on the question on why he is recovering well, most patients do achieve some degree of recovery after stroke. That is not to mean that the damage is reversed, but that is thanks to the remaining undamaged cells creating new connections with each other trying to compensate for the lost cells. This process is called plasticity. To what degree this process takes place and its speed can not be predicted precisely, it does vary among individuals. Young patients do have greater plasticity potential, better chances of that happening, which I think has been the case in your husband, showing recovery already in the first week is a positive thing. As for what can be done to support that, physio and speech therapy are the only proven means, they will be continued for months.

What is as important on the other hand is trying to find a cause, in order to prevent other strokes from happening. If the imaging tests of the head and neck vessels haven't evidenced atherosclerotic plaques or dissection as the cause, then the most common cause is the heart. For that the initial test is a ultrasound followed when normal by transesophageal echocardiogram with bubble tests which gives a better view of the posterior part of the heart and aorta. So for the moment its results are necessary.

If that as well does not reveal a cause then a heart rhythm abnormality must be sought. I imagine he has already had an EKG which was normal, but there are also episodic arrhythmia like paroxysmal atrial fibrillation, which can last only for short periods of time (even less than a minute) which may not happen to be during the routine EKG, so not detected, but are enough to form clots. So to look for that more prolonged monitoring is done, initially for at least 24 hours (through Holter ECG, a portable device easily carried during daily activity). If that is normal more prolonged studying may be done for a week, a month, now there are even implantable monitoring devices for longer than that to detect such arrhythmias (their availability depends also on healthcare system where you live and what they reimburse).

Whether such tests always find a cause...no...that is not always possible, there is a portion of patients in whom even after extensive testing no cause can be found. It is very frustrating for doctors and patients alike but it is so, even more common in younger patients under 50. However it is early to speak about that, for now as I said it is necessary to dig as deep as possible through tests.

I remain at your disposal for further questions.

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Brief Answer:
Nothing of proven benefit.

Detailed Answer:
Hello again. Sorry for answering a little late but I had missed your question in the morning and later got caught up at the hospital.

It is a question to which I have to answer often. There are many products which have been tried over the years like cerebrolysin, piracetam, gliatiline etc, these last couple of years the most promoted is Neuroaid. These products are promoted but studies eventually have shown no significant benefit for any of them, they are not included in any protocol or guideline, because none has proven beneficial.

I do not have a direct personal experience with Etanercept although I did some research on it a few months back when someone on this site asked a similar question to yours. I found no evidence on its benefit on any well known stroke or neurology journal, no serious clinical trials on course either. Most of the sources I found were publications of a clinic where it was used by not even a neurologist but an internist charging some exorbitant prices, so I can't really accept them for now, there might be commercial interests involved. As long as there are no respected studies I can not recommend the product I am afraid. For now only physiotherapy has had proven benefit I am sorry. If such products will come along and proven in the future believe me I would be very happy to prescribe them, to offer something to my many stroke patients.

I hope to have been of help.

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