A 39-year-old male presented with flaccid paralysis of his left upper and lower extremities. He was initially a stroke alert but had negative imaging. On re-evaluation, cauda equina was suspected. On yet another re-evaluation, he confessed to using multiple illicit substances and that his extremities were becoming increasingly painful. A diagnosis of left-sided compartment syndrome was finally made but only after repeatedly going back into the room, re-examining and re-questioning the patient; compartment syndrome can be a mimicker of stroke and cauda equina and, ultimately, prompt care for this critically ill patient was only obtained after lengthy advocacy with skeptical consultants.
