An 83-year-old right-handed, Hispanic woman with history of hypertension, diabetes, dyslipidemia, and prior right frontal lobe infarction without residual deficits presented with sudden onset of severe dysarthria, dysphagia and left facio-brachio-crural weakness. Initial neurological examination revealed severe spastic dysarthria, left upper motor neuron type of facial paralysis, left tongue deviation and left-sided hemiparesis. Her mouth was half open and she could not close it when asked to do so but could close it spontaneously and when she smiled. Sneezing and yawning were intact. She had no aphasia, alexia or agraphia. A formal swallowing evaluation confirmed severe oropharyngeal dysphagia. MRI brain showed acute infarction on the right frontal operculum and preexisting extensive bilateral leukoaraiosis. No evidence of brainstem lesion was seen on the MRI. Diagnostic work up including lipid panel, CT angiogram head and neck, echocardiogram, and telemetry were unremarkable. She was treated with aspirin and atorvastatin for secondary stroke prevention. During the two-week follow-up, her speech, swallowing function, and voluntary facial movements partially improved.