Stroke following manual strangulation is a rare presentation. We report a case of 61-year-old man with no known comorbidities presenting with right hemiplegia following manual strangulation. Neuroimaging showed left middle cerebral artery territory infarct along with left posterior watershed infarct. Although isolated cases of thromboembolic stroke and watershed infarcts have been reported, combined watershed infarct and thromboembolic stroke in a person has not been reported till date to the best of our knowledge. The probable mechanism is discussed based on literature review. The need for anticipation of delayed cerebrovascular injuries and appropriate investigations in all strangulation victims who arrive at emergency department is also stressed upon based on this case report.
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