Varicella zoster virus vasculopathy is a condition that can classically present with a dermatomal zoster rash followed by a neurological deficit. The possible neurological manifestations and disease range are extensive. Diagnosis becomes more challenging in patients whose presentation does not include a rash, often causing cognitive errors and delay in treatment. We present a case of an 85-year-old patient, who developed stroke-like symptoms, initially with normal MRI, to later progress to multiple evolving enhancing lesions seen in subsequent MRIs. This case also represents the anchoring, that we as physicians can have when a patient with risk factors for stroke or TIA, presents to the emergency department complaining of unilateral weakness
