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70-year-old man with migraine with an aura of scotoma and strabismus initially presented with hallucination status-post atrial fibrillation ablation. He reported 45 minutes of seeing vivid yellow numbers and colors throughout his vision. Imaging demonstrated no acute infarct. After discharge, he developed recurrent, intermittent, unprovoked, and acephalgic hallucinations of vivid, colorful, and patternless numbers and letters. Though typically brief (1-5 minutes), some lasted an hour. His migrainous auras were different; a pre-cephalgic scotoma and “cellophane” photopsia. Physical examination was unremarkable except baseline strabismus. He returned one week after discharge with acute cervicalgia and vertigo. Head and neck MRA found a chronic occluded right vertebral artery with collateral filling. He was discharged on aspirin, plavix, and a high-intensity statin. Two months later, the patient returned with transient vertigo and right-sided weakness with similar visual hallucinations. MRI brain demonstrated accumulating posterior circulation ischemic stroke burden (acute and subacute infarcts) and CTA redemonstrated right vertebral occlusion but revealed severe short-segment stenosis of the left vertebral artery seen on prior imaging in retrospect, confirmed by digital subtraction angiography. After failure of maximal medical management, he underwent balloon-inflated coronary stenting with no recurrence of hallucinations or transient vascular symptoms despite post-procedural thalamic hemorrhage.