This case describes a patient with multiple stroke risk factors—including prior stroke—who presented to the emergency department with symptoms suggestive of stroke and who received a rapid stroke work up but was later found to be in non convulsive status epilepticus (NCSE). This case report highlights the challenge and importance of making an accurate diagnosis in NCSE, and we have included teaching points to help clinicians understand the clinical manifestations and diagnosis of NCSE as well as how it may impact a patient's prognosis. Given the growing attention to rapid stroke protocols in emergency departments across the country, it is important to remember that not all that appears as stroke is stroke, even in people who are at high risk for stroke or in whom stroke is the most likely cause of their neurologic deficits.