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The contralaterality of hemiplegia in stroke is an axiom of practical clinical neurology. But not all hemiplegic patients have contralateral intracranial lesions. We present a suspected (MRI negative) right subcortical stroke in an octogenarian with left hemiplegia and standard risk factors for stroke. However, further investigations and re-examination showed an unusual infra-cranial cause for flaccid, left lateralising and predominantly proximal upper and lower limb weakness.