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Background: Acute ischemia typically results in a flaccid paralysis. An immediate spastic hemiparesis following ischemia has rarely been reported. One case involved a left hemispheric transient ischemic attack and the other cases occurred after intracerebral hemorrhage. Case Report: A 46-year-old male developed an immediate spastic hemiplegia shortly after coil embolization of an unruptured anterior communicating artery aneurysm. A CT perfusion scan at the time of these symptoms demonstrated hypoperfusion in the right anterior cerebral artery (ACA) territory. The patient was emergently taken back to the angiography suite where he was found to have right A2 ACA occlusion. Following abciximab infusion, the artery recanalized and the patient’s symptoms resolved. Repeat CT perfusion demonstrated resolution of the perfusion deficit in the right ACA territory and the patient’s neurological exam remained normal. Conclusion: Acute ACA ischemia can present with spasticity in the hyperacute period instead of flaccid paralysis.