This medical case study follows a 68-year-old man presenting with abrupt aphasia, right-sided weakness, facial drooping, and other findings that localize the lesion to the dominant left middle cerebral artery territory. Clinical history, neurologic examination, laboratory testing, and neuroimaging are used to distinguish an acute ischemic stroke from hemorrhage, seizure, migraine, metabolic abnormalities, and other important mimics. The case also reviews time-sensitive treatment decisions, including intravenous thrombolysis, mechanical thrombectomy, blood-pressure management, and long-term prevention of cardioembolic stroke.

A previously healthy 32-year-old man develops progressive bilateral lower extremity weakness that ascends to involve the upper limbs over several days. Symptoms began approximately ten days after an episode of severe watery diarrhea that had resolved with supportive care. On examination, he exhibits symmetric limb weakness, absent deep tendon reflexes, distal paresthesias, and early signs of respiratory compromise, prompting urgent neurologic evaluation.

After a stable psychiatric patient is treated for a common infection, he presents with a rapid onset of high fever, profound muscle stiffness, and declining consciousness. This high-yield case requires clinicians to look beyond the obvious signs