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Background: Traditionally, in the rehabilitation setting, side of stroke lesion can be predictive of rehab potential. The purpose of this case report is to highlight the comprehensive rehabilitation of a unique presentation of ipsilateral involvement in a stroke patient. Case Description: The subject of this case, a 63-year-old male, presented with right-sided hemiparesis, right ptosis, 3rd cranial nerve paresis with extropia and dysmetria due to a hemorrhagic stroke that caused damage to the right side of his brain. Although rare, his presentation and imaging results can occur simultaneously. Intervention: Physical therapy sessions with the patient occurred five days per week and lasted approximately 50 minutes. Sessions consisted of gait training, strengthening, cognitive interventions, and activity-based interventions. Outcome: The resident spent a total of 88 days at the comprehensive rehabilitation center. At the time of discharge, the resident was able to ambulate household distances independently with a single point cane, and long distances with supervision and the same assistive device. He was also able to ambulate over 700 feet without an assistive device or hands-on assistance. His BERG score at discharge increased far beyond the six to seven points required for minimal detectible change. Due to his improvements in cognition, balance and safety awareness he was also able to return to some of his prior cognitive and physical work tasks on the farm. Discussion: It is vital to understand the importance of personal factors that lead to the individualized care and return to function.