The patient has a history of sickle cell disease, pulmonary hypertension, and right ventricular enlargement, likely secondary to the sickle cell disease. He previously had a transthoracic echocardiogram that did not show any intracardiac shunting but did show a left ventricular ejection fraction of 50–55 %. He was taking a beta-blocker and an angiotensin-converting enzyme inhibitor for blood pressure control. He did not have any other significant history. On arrival to our hospital, the patient appeared toxic and in severe distress. The patient had moderately altered mental status but was able to follow conversation. He complained of worsening diplopia and decreasing vision from his right eye. His physical examination was significant for abnormal sensation below the level of C4 and decreased motor strength in all four extremities.