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. The gene discussed is SLC19A2; the disease is megaloblastic anemia.