A 65-year-old hypertensive black man presented to the emergency department with onset of right face, arm, and hand paralysis, and difficulty communicating. Rapid diagnostic testing using MRI revealed an ischemic infarct in the left middle cerebral artery (Figure 230-1). He was evaluated by a stroke response team and was found to be a candidate for tissue plasminogen activator (TPA). After the stroke, he was treated with aspirin, antihypertensives, and cholesterol-lowering medication. He recovered 80% of his neurologic deficit over the next 3 months. Figure 230-2 is a noncontrast CT image of this patient 2 weeks later.