PURPOSE: Giant cell arteritis can have protean manifestations, many of them non-specific. We describe a patient whose initial presentation was most consistent with brainstem stroke, but who was ultimately diagnosed with and treated for giant cell arteritis. OBSERVATIONS: A 76-year-old woman presented with abrupt onset diplopia, headache, nausea and vomiting. On presentation to the emergency department, she was diagnosed with a brainstem stroke and treated with tissue plasminogen activator. When her symptoms did not remit, closer inspection of her imaging revealed enhancement within the orbits and enhancement of her superficial and posterior temporal arteries. These findings led to the consideration of giant cell arteritis. Her signs and symptoms resolved with steroid treatment and a temporal artery biopsy was positive. CONCLUSIONS AND IMPORTANCE: This case highlights the emerging role of MRI and other imaging techniques in improving our ability to non-invasively diagnose giant cell arteritis.