A 49-year-old Caucasian male, left-handed, with no known comorbidities, working as a middle school teacher, presented to the emergency room with a sudden-onset left hand weakness described as difficulty gripping with no other associated symptoms. A non-smoker, non-alcoholic beverage drinker, with no illicit drug use. There was no significant history of any neurological disease in the family background but his father has a history of interatrial septal aneurysm. Physical, cardiologic and neurologic examination at the emergency department were unremarkable aside from the weakness on his left hand and a mild sensory deficit on the left upper extremity. A cranial magnetic resonance imaging with magnetic resonance angiography was done which showed a hyperacute infarct in the right frontal lobe, with paucity of vessels and attenuation of flow-related signals in the M4 perforators of the right middle cerebral artery and contour irregularities along the intradural segment of the right vertebral artery relating to atherosclerotic changes (Figure 1). Patient was given a recombinant tissue plasminogen activator since he came in at the 3rd hour post-ictus. Laboratory tests done at the emergency department showed normal complete blood count, routine blood chemistry, A further work-up was done which showed a slightly elevated LDL on Lipid profile, and other parameters within normal limit.