We present a 30-year-old African American female with a medical history of hypertension, diabetes mellitus, and recurrent ischemic stroke who presented with left leg weakness and gait imbalance. In addition, she described transient symptoms of headache, tinnitus, and an inability to ambulate which preceded each of her recurrent strokes. Brain MRI revealed several small acute infarcts involving the corpus callosum, right thalamus and cerebral peduncle, and right parietal lobe. CT angiogram was significant for chronic occlusion of the right ICA with reconstitution of the supraclinoid ICA. Diagnostic DSA was not suggestive of moyamoya-patterned revascularization. Laboratory workup revealed elevated ESR and CSF protein. Due to suspicion of possible SuS, ophthalmic evaluation was obtained to reveal bilateral retinal microaneurysms and cotton wool spots on fundoscopic exam. She was discharged on oral steroids with planned outpatient audiometry testing and ophthalmology follow up.