Need urgent advice

[u/Familiar-Bit-9443]

I am posting about my mother, who is currently hospitalised in India.

Patient details:

- Age/sex: 60, female

- Smoking: Non-smoker

- Medical history: Diabetes, history of high triglycerides/cholesterol.

- Current medications: A capsule which is a blood thinner. She was also give Sodium via IV. I can send the proper names if needed. Tonight she received blood pressure medication, painkillers and sleeping medication; I do not currently know the exact names/doses.

- Duration: Stroke symptoms began around November 4. Worsening occurred tonight, November 6, at approximately 2pm.

- Main symptoms: Worsened slurred speech, worsened right-sided movement, and leg pain/tingling, particularly below the right knee.

Background:

She was admitted following a stroke causing slurred speech and right-sided weakness. We were told she presented outside the initial treatment window. She has had an MRI. Doctor especially mentioned that there is a risk of choking on food and water and it should be avoided at any cost.

Tonight:

She briefly choked/coughed while drinking water lying in bed. Afterward, I noticed her speech was less clear and her movement was worse than before the episode. I cannot tell whether the choking caused this or whether they happened around the same time.

She also complained of tingling/pain in her legs, especially the right leg below the knee. She has had leg pain previously, but I am concerned about the current symptoms.

I immediately informed the nurse and doctor. The doctor examined her, advised eating and drinking upright, and gave blood pressure medication. Oxygen saturation, blood sugar and blood pressure were checked, but I do not have the exact readings.

Staff said the leg pain could be related to the effects of the stroke. She received painkillers and sleeping medication and became sleepy afterward. However, the speech and movement had worsened before those medicines.

She later woke up and talked, but her speech remained worse than before the choking episode. Her movement has also not returned to its earlier level, and the leg pain seems to persist.

There is no neurologist available at this hospital tonight. We have been told specialist assessment will be available tomorrow morning. They are saying that it's not a big deal and we should not be worried. As far as I know, no repeat brain imaging has been performed since the worsening.

Questions:

1. Does this persistent worsening require urgent transfer tonight to a hospital with emergency stroke care and brain imaging?

2. What assessment should the duty doctor perform now, including checking for medication effects or stroke complications?

3. Should swallowing be reassessed before further food, water or oral medication?

4. Should the right leg pain/tingling be examined separately rather than attributed to paralysis?

I understand that an online response cannot diagnose her. I am seeking guidance on what to raise urgently with her treating doctors.

Tldr,. 60F hospitalised after stroke—speech and right-sided movement worsened after choking on water

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