I am board-certified in vascular neurology (stroke), and I directed a comprehensive stroke center in New England for almost 15 years. I am initiating a neurohospitalist division at a regional neuroscience institute. About 60% of my clinical practice is based in the hospital, largely in the care of acute stroke patients who are admitted to our neurology residents’ teaching service at a well-known university. We also staff a vascular neurology fellowship at our major teaching hospital. As for this case, typically these patients are coming out of general anesthesia. Because they will initially be sedated, it makes diagnosing a stroke initially a challenge. They are also often subjecting to controlled hypotension by the anesthesiologist in order to minimize bleeding in the operative field. Patients who have just had surgery are at a modestly elevated risk for ischemic stroke also because longterm blood thinners are generally held a few days prior to surgery. The common non-invasive modalities are head CT and brain MRI scans, and their associated tests to assess the arterial treat, CT and MR angiography.