Patient description: A 62-year-old African-American man presented with left upper and lower extremity weakness, associated with dark visual spot in right eye, right facial numbness, facial drop and slurred speech. He denied dyspnea, headache, palpitations, chest pain, fever, dizziness, bowel or urinary incontinence, loss of consciousness. His medical history was significant for hypertension, hyperlipidemia and hypothyroidism. He smokes cigarette 1 pack per day for 40 years and alcohol consumption of 5 to 6 beers per week. He is not aware about his family history. He is using Levothyroxine, Atorvastatin and HTCZ. His vital signs were stable in the primary evaluation. Left-sided facial droop, dysarthria, and left-sided hemiplegia were seen in the physical exam. His National Institutes of Health Stroke Scale (NIHSS) score was calculated as 7. Initial CT angiogram of head and neck reported no acute intracranial findings. Intravenous recombinant tissue plasminogen activator (t-PA) was administered as well as high-dose statin therapy. The patient was admitted to the intensive care unit to be monitored for 24 hours. MRI of the head revealed an acute 1.7-cm infarct of the right periventricular white matter and posterior right basal ganglia.

Clinical trial eligibility criteria: eligible ages (years): 21.0-60.0,  Brain Concussion Closed head injury within the past 24 hours with history (loss of consciousness, amnesia, mechanism of injury such as motor vehicle collision or fall from height) or specific symptoms and signs (headache, vomiting, dizziness, head injury, short-term memory deficit, confusion, blurred vision, balance problems) that prompts computerized tomography (CT) brain evaluation as determined by an emergency physician. 2. Age 21 through 60 years of age. 3. Initial Glasgow Coma Score of 13 or greater at time of ED presentation with normal neurologic examination and Glasgow Coma Score of 15 within two hours of initial assessment. 4. Normal neurologic examination in the emergency department except for symptoms and signs described above (e.g., no focal neurologic deficit). 5. Normal brain and skull on CT scan in the ED. 6. Working cellular phone (for follow up assessment)  Significant concomitant non-cranial injury requiring pain medication (e.g., facial fracture, severe extremity injury, major blunt trauma.) 2. Any type of skull or cervical spine fracture. 3. Post-traumatic seizure. 4. Currently taking acetaminophen, or other pain medications on a regular basis. 5. Currently taking ANY coagulant medication (e.g., Plavix, aspirin, Xeralto, Coumadin). 6. Any bleeding disorder, predisposition to bleeding, or history of gastrointestinal bleeding. 7. Pregnancy. 8. Clinical intoxication with alcohol or illicit medication. 9. Chronic alcohol abuse. 10. Any liver or renal dysfunction or failure. 11. Justification of obtaining CT brain evaluation that included patient being intoxicated. 12. Intolerance, allergy or adverse reaction to either ibuprofen or acetaminophen. 13. Any current or previously diagnosed cardiovascular condition (e.g., hypertension, coronary arterial disease, myocardial infarct, angina, congestive heart failure, pulmonary embolism, deep venous thrombosis). 14. Any current or previously diagnosed neurovascular condition (e.g., stroke, TIA, multiple sclerosis, seizure disorder). 15. Any active cancer or malignancy