Hello ! Its pleasure to answer your query. As per the MRI report,he has an acute stroke episode.There are many risk factors for stroke including hypertension,atherosclerosis,vasculitic disorders,central nervous system infections,embolic phenomenon and many more. As ECHO Cardiogram is normal for your patient hence it seems to be acute thrombotic episode involving right middle cerebral artery. For treatment he needs urgent admission in specialized hospital or stroke unit.Along with nursing care,physiotherapy he needs oral antiplatelet drugs such as aspirin,clopidogrel,ticlopidine,dipyridamol and oral statins such as rosuvastatin/atorvastatin. If he could have presented within 3 hrs from symptom onset there could have been a option of thrombolysis depending upon size of infarct,age of patient,blood pressure at the time of presentation and other major medical illness or past history of major surgery.This decision of thrombolysis is physician dependent as there is a major risk of bleeding during thrombosis. As carotids are normal on MRA and Carotid doppler is normal there is no need of any interventions for this. Adequate control of blood pressure,blood sugar,lipids could help to prevent further episodes of stroke. Improvement in this episode depends upon the level of conciousness of your patient,degree of weakness in limbs and size of the infarct on MRI. NIHS scale can help in assessment of prognosis and management of your patient.You can take help of treating physician regarding this. Healthy lifestyle,exercise,diet monitoring of blood pressure and sugar,physiotherapy long term antiplatelet agents and statins can definitely help in improvement.It may take one to two months for maximum improvement. Hope you have satisfied with the answer.If you need any further information i am always happy to help. Thank you and wish you a better health.