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Acute Hemiplegia is generally a sign of a serious medical condition most likely of vascular origin; it should prompt immediate investigations and management as symptoms and signs may remain indefinite if irreversible damage and infarction occurs. It is important to quickly rule out or treat a stroke, as time is brain. Here is what you need to know when someone presents to the emergency room with hemiplegia and/or hemisensory loss with or without aphasia. One General Assessment Start with the ABCs, place the patient on full vital monitoring, and check their glucose. Two Get a History It is important to know the time the patient was last awake and symptom free. Prepare for possible thrombolysis if symptom onset is known to be under 4.5 hours. Ask questions to rule out conditions mimicking stroke, such as seizure history, migraines, hypoglycemia, and conversion disorder. Three Investigations and Imaging Order a non-contrast CT head scan immediately to rule out hemorrhage and to