12/20/21 ED note from RN-Pt's wife reports that last known well was last night. She states that he woke her up this AM and was unable to talk. She states that he had a TIA in November. Pt is unable to make intelligible conversation.12/20/21 ED note from Dr. -Chief Complaint:  Stroke Symptoms.HISTORY OF PRESENT ILLNESS:Date of birth 6/19/1950, is a 71 y.o. male who presents to the Emergency Department complaining of stroke symptoms. According to the nurses report, the patient's wife states that the patient started to develop difficulties speaking and increased confusion starting at around 10:00 am today (12/20/21). The wife of the patient states that she woke up the patient this morning and was unable to verbally communicate with her. The wife states that at baseline the patient does not have significant speech deficit, so he was brought to the ED for evaluation. The patient's wife does note that the patient has recently suffered a TIA in November 2021, but states that the patient is acting much different than he did during his previous episode. The patient has went to speech therapy for previous symptoms suffered from a TIA. Patient is unable to verbally communicate with the medical staff at this time due to his condition. The patient has a past medical history of hypercholesterolemia, bladder cancer hypertension, anxiety, and headaches. The patient is currently taking a baby aspirin and Plavix.Update from the patient's wife states that the patient was last seen well yesterday night at 21:00 (12/19/21). Therefore the patient is not a candidate for tPA at this time.  Caveat: Full history of present illness is unobtainable from patient secondary to condition. 12/20/21 H&P from Dr. -PCP: APRN:Chief Complaint:  Aphasia.HPI: is a 71 y.o., male with medical history significant for previous CVA in 11/2021 on aspirin and Plavix, nicotine dependence, bladder cancer and anxiety who presents with aphasia .patient's wife states that the patient started to develop difficulties speaking and increased confusion starting at around 10:00 am today (12/20/21).  she woke up the patient this morning and was unable to verbally communicate with her. wife states that at baseline the patient does not have significant speech deficit, so he was brought to the ED for evaluation. patient's wife does note that the patient has recently suffered a TIA in November 2021, but states that the patient is acting much different than he did during his previous episode. The patient has went to speech therapy for previous symptoms suffered from a TIA. Patient is unable to verbally communicate with the medical staff at this time due to his condition.  patient is not a candidate for tPA due to unknown onset of time ( after ER attending had tele stroke consult). CT angiogram of head showed left ICA occlusion .  MRI of head requested and patient is now being admitted for acute stroke. NIH stroke scale of 8.Active Hospital Problems   (*Primary Problem).Diagnosis Acute CVA (cerebrovascular accident) (CMS HCC).12/21/21 consult note from Dr. Chief Complaint: speech problems ;History of Present Illness: History was obtained from a review of the electronic record and discussion with the patient and family.  is a 71 y.o. male is a 71-year-old gentleman who presented to the hospital on 12/20/2021 after having significant speech problems and right-sided weakness.  The patient recently had a stroke in November at which point he was found to have occluded left ICA and he was treated with best medical management and he was discharged on dual antiplatelet therapy and high-dose statin.  The patient does have extensive history of smoking.  The patient presented back on 12/20/2021 after having worsening weakness and speech problems.  The patient had repeat CT angiogram which did not reveal any acute abnormalities but MRI brain showed new embolic appearing strokes in the left MCA territory.  These were new compared to the previous MRI in November.  The patient was evaluated at bedside.  He was clinically improving.  He continued to have significant speech problems.Follow up with PCP.