A forty two year old male with a past medical history of hypertension, bipolar disorder, and ADHD presented to our institution after being found unresponsive by his roommate. Urine toxicology was positive for fentanyl and cannabinoids. MRI brain demonstrated bilateral cerebellar, hippocampal and basal nuclei diffusion restriction changes. He was admitted to our neurocritical care unit and cerebral edema was managed with hypertonic saline. He was stabilized and discharged to inpatient rehabilitation. Twenty days post discharge he represented to our institution after a unwitnessed fall with loss of consciousness. During this admission he was evaluated by the general neurology in-patient consult team and noted to have masked facies, hypophonia, bradykinesia, shuffling gait, and micrographia. We suspect that his parkinsonism was secondary to bilateral basal ganglia abnormalities noted on imaging.