A 65-year-old right-handed woman with a history of hypertension, remote tobacco use, depression, and anxiety presented to our hospital with acute onset of bilateral flinging arm movements and speech arrest witnessed by her boyfriend. She arrived at the emergency department (ED) within 1 hour of the symptom onset. On examination, she was hypertensive with a normal heart rate and temperature. She was awake and alert and only followed commands when asked to raise her legs. She mimicked eye closure and raised 2 fingers in both the hands. She had very little to no spontaneous speech and only answered questions with different random numbers throughout her stay in the ED. During attempts to name a pen or knuckles, she only verbalized numbers; reading and writing were not assessed. On cranial nerve examination, there was a slight right central facial nerve palsy. She moved all limbs equally against gravity. The flinging arm movements had resolved upon arrival at the ED. Her sensory examination was grossly normal as she withdrew her limbs to noxious stimulation, and her National Institutes of Health Stroke Scale (NTHSS) was 7.
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