SLC19A2 and thiamine-responsive megaloblastic anemia syndrome: These rare pathologies led to an atypical stroke presentation and emphasize the complexity of vasculopathies, the importance of thorough workup, and the benefits of surgical intervention. Rogers syndrome (TRMA) is caused by mutations in the SLC19A2 gene, leading to defective thiamine transport and a clinical triad of DM, sensorineural hearing loss, and megaloblastic anemia.