The clinical burden of peripheral arterial events is substantial, with high case fatality, poor functional outcome, and a high rate of emergency and subsequent vascular intervention to prevent death and limb loss . We present a case of left upper extremity paresis secondary to acute brachial artery occlusion in an elderly female with active non-ST segment elevation myocardial ischemia (NSTEMI) in the setting of paroxysmal atrial fibrillation. The patient was initially suspected to have a cerebrovascular attack (CVA); however, computed tomography (CT) head was negative for acute stroke. The presence of skin mottling, coolness of the arm, pallor, decreased sensation, and pulseless led to a further investigation with a computed tomographic angiography (CTA) of the upper extremity, confirming the diagnosis of acute left brachial artery occlusion. Acute limb ischemia should be considered in the differential diagnosis of acute stroke with atypical presentation.