Methylphenidate for Ptsd and Stroke Veterans

Inclusion Criteria: * Male or female Veteran of US military; signed informed consent * Criterion A Index Trauma(s) resulting in PTSD occurred during adulthood prior to stroke * CAPS-5 past week total score =23 at baseline visit * Willing to refrain from antipsychotics, mood stabilizers, stimulants, and any formulation of MPH * First-ever symptomatic ischemic stroke radiologically verified, occurring within past 1-12 months * Females of child-bearing potential (i.e. not postmenopausal or surgically sterile) must be using a medically acceptable method of birth control and should not be pregnant nor have plans for pregnancy or breastfeeding during the study Exclusion Criteria: * Moderate to severe cognitive impairment (Montreal Cognitive Assessment score \<16/30) * Poor pre-stroke baseline function of a modified Rankin score \>2 * Presence of any standard MRI contraindications * Current diagnosis of DSM-5-defined bipolar disorder I, schizophrenia, schizoaffective disorder, obsessive-compulsive disorder, or major depressive disorder with psychotic features (MINI) * Diagnosis of moderate or severe substance use disorder (except for caffeine and nicotine) during the preceding 3 months * Patients who utilize alcohol or cannabis but do not meet criteria for moderate or severe disorder are permitted at the discretion of the investigator * Participants must agree to abstain from illicit drugs during the study * Increased risk of suicide that necessitates inpatient treatment or warrants additional therapy excluded by the protocol; and/or intensity of suicidal ideation (Type 4 or Type 5) or any suicidal behavior in the past 3 months on Columbia Suicide Severity Rating Scale (C-SSRS) * Use of any investigational drug, MPH formulation, antipsychotics, mood stabilizers, monoamine oxidase inhibitors, stimulants or any medication known to be a potent (strong) cytochrome P450 subtype 3A4 inhibitor within 2 weeks of baseline * Treatment with evidence-based trauma-focused therapy for PTSD within two weeks of baseline (if participant is receiving therapy, he/she must complete treatment prior to entering study) * Supportive psychotherapy in process at time of Screening may be continued during the study. * History of moderate or severe TBI as defined by the Ohio State University TBI Identification Method * Based on investigator's clinical judgment, history of mild TBI is not excluded * Any clinically significant, uncontrolled, or medical/surgical condition or laboratory abnormality that would contraindicate use of MPH (see Human Subjects section) * Severe allergic reaction, bronchospasm, or hypersensitivity to any MPH formulation. * Litigating for compensation for a psychiatric disorder. Veterans who are in the process of applying for or receiving VA service-connected disability are eligible * Current enrollment in another intervention trial for PTSD or stroke * Persons imprisoned, diagnosed with terminal illness, or require surrogate for consent