Introduction: A 58-year-old male presents to the emergency department with headache, hand numbness, and phantosmia.

Case Presentation: Magnetic resonance imaging showed multiple acute and early subacute lesions involving the cortex and subcortical white matter of the left frontal lobe, left parietal lobe, left temporal lobe, left caudate, and left putamen.

Discussion: This case takes the reader through the subtle findings that led to the diagnosis and ultimately to treatment.