Basilar Artery Syndrome (BAS), also known as Rostral Brainstem Infarction, accounts for 1% of all strokes, with an annual incidence of four patients per 100,000. Top of the Basilar Syndrome (TBS) is characterized by multiple ischemic lesions on diffusion-weighted imaging (DWI) involving more than two territories supplied by branches of the distal basilar artery (cerebellum, hypothalamus, medial diencephalon, and medial thalamus), and occlusion of the distal one-third of the basilar artery (BA) on both time-of-flight magnetic resonance angiography (MRA), and contrast-enhanced MRA. It re sults from thromboembolic occlusion of the top of the BA. Risk factors include hypertension, diabetes mellitus, obesity, hyperhomocysteinemia, and excessive alcohol intake. Cardiogenic emboli, such as mural thrombi in myocardial infarction, atrial fibrillation, and valvular thrombi in infective endocarditis and valvular heart disease, can also be causative. Hyper coagulable states, like anti phospholipid antibody syndrome, protein C deficiency, and protein S deficiency, may also predispose to thrombotic events. Small vessel vasculitis in sickle cell disease can be associated. Bilateral thalamic ischemia occurs due to occlusion of per for at or vessels. Clinically, patients develop symptoms like visual and oculo-motor deficits and behavioral abnormalities, while motor dysfunction is often absent. This case report describes a 78-year-old man presenting with a generalized seizure and decorticate posturing secondary toTBS, a rare manifestation of a posterior circulation stroke.