A 47-year-old woman had inability to speak and swallow that had started 4-5 hours ago. She had necrotic lesions in the toes of both feet and had a history of smoking. Acute and chronic ischemic lesions were diagnosed on imaging. She was diagnosed with thromboangiitis obliter-ans by digital subtraction angiography. This report discusses a rare cause of ischemic stroke and the lack of data on diagnosis and treatment. Key Words: Buerger’s disease, Vasculitis, Stroke, Smoke, Neuroimmunology