Echocardiography showed anterior, septal, apical and anterolateral wall hypokinesia with two apical thrombus measures 1110 cm ,1012 cm subsequently with moderately impaired left ventricular systolic function (Ejection Fraction=34) favoring the decision of adding furosemide 40 mg tabs once daily and spironolactone tabs 25 mg once daily. See Figure 1

The patient was followed up closely symptomatically with serial ECGs on the subsequent days showing significant improvement until day 4 of Admission in the evening follow up when he was found to have slurred speech and he mentioned that he was unable to move his right side, without mouth deviation, headache or blurring of vision. On examination he was afebrile, conscious, oriented in time, place and person. There was bulbar cranial nerves affection (without fascial palsy), right side hypotonia, power grade 3 and hyporeflexia. The patient was sent for urgent brain CT scan which showed left parietal area infarction. See