Despite brilliant clinical recovery, our patient displayed severe suicidal ideation on Day 3. He had never suffered from depression or any psychiatric illness in past. Brain magnetic resonance imaging showed an acute lacunar infarction in the putamen. Repeat TCD showed considerably elevated flow velocities in right MCA (3 times more than the left). Further evaluation of cerebral hemodynamics by CT-perfusion (CTP) revealed relative right MCA territory hyperperfusion (Figure 1). Suspecting that regional hyperperfusion was responsible for his suicidal ideation, we refrained from initiating any medications. Head-up position, fluid restriction, and aggressive blood pressure control (to 120/80 mmHg) resulted in rapid improvement in psychiatric features during the next 2 days. CTP performed on Day 6 revealed normalization of cerebral perfusion parameters (Figure 1). Since his hospital discharge, on Day 7, he has remained well during the past 1 year.