71-year-old female with a history of hypertension presented to our Emergency Department after being found down and unresponsive the with last known well approximately four hours prior. She was intubated, sedated and paralyzed at time of the initial neurologic exam. Rapid MRI was initially unremarkable and CT angiogram showed a narrow but patent basilar artery without thrombus. Repeat MRI obtained the following day showed restricted diffusion in the bilateral ventral pons with extension to the tegmentum.  The patient was diagnosed with LIS with exam notable for quadriplegia with preserved consciousness and extraocular movements. After initially presenting hypothermic with a rectal temperature of 93F, the patient began to fever 7 hours after arrival with a temperature of 100.8F. She continued to spike fevers throughout her first 12 days of hospitalization despite treatment with broad spectrum antibiotics, antipyretics and cooling blankets with rectal temperatures ranging from 99.0F to 101.5F. Infectious workup, including blood, sputum and urine cultures were consistently negative. At time of discharge, the patient’s temperature had begun to normalize and the patient had regained the ability to tap her right index finger.