We present a case of a 66-year-old man who presented with a history of Right Hemianopia and Right sided facial droop and weakness. CT and MRI brain imaging demonstrated areas of infarction affecting the vascular regions supplied by Left Middle Cerebral Artery and Left Posterior Cerebral Artery circulation. Carotid Duplex Arterial imaging demonstrated moderate Left Internal Carotid Artery Stenosis and CT Angiography demonstrated a dominant Left Posterior Communicating Artery. The origin of the multi-territory Stroke as demonstrated on the MRI scan was his underlying Carotid disease. The patient underwent a successful Left Carotid Endarterectomy.

This case highlights the fact that patients presenting with isolated Posterior Cerebral Arteryterritory stroke or mixed Posterior Cerebral Artery and Middle Cerebral Artery territory strokes and ipsilateral Internal Carotid Artery stenosis, should have a low threshold to be assessed with CT or MR Brain Angiography to determine if variants in Cerebral Circulation exist.