Case Summary: In less than 400 words, please summarize the case. Briefly describe the case and any particular complexities and/or complications encountered.: A 43-year-old man was diagnosed with Fabry disease when he had lacunar infarction of right putamen 8 years before the admission and was treated with agalsidase α. He had recurrent infarction in the right side of the midbrain 6 years ago and in the left corona radiata last year, but was independent in daily life with only residual right lower extremity sensory disturbance and modified Rankin Scale score was 1. This time, he was presented to our hospital with sudden-onset right hemiplegia and dysarthria from the time he woke up, and his NIHSS score was 2. Head MRI showed acute cerebral infarct in the left internal capsula. He was hospitalized and dual antiplatelet therapy (cilostazol 200 mg added to the aspirin 100 mg that he had been taking) initiated as acute lacunar infarction, but a few hours later, his right hemiplegia worsened in stepwise, and he also developed sensory deficit in the right side of his body. On the same night, his NIHSS score worsened to 5 and argatroban infusion was added, but his right hemiplegia continued to worsen. On the second day, his NIHSS score reached 10, and he required tube feeding due to marked dysphagia caused by pseudobulbar palsy. Follow-up head MRI performed on the 12th day showed that the infarct was enlarged in the anterior-posterior direction, and the course of disease was compatible with branch atheromatous disease (BAD). After rehabilitation, his right hemiplegia and pseudobulbar palsy improved with time, and he was weaned off tube feeding. He was transferred to a rehabilitation hospital on his 53rd day with a NIHSS score of 3 and mRS score of 4.