Background: Patient with small thalamic infarct may present with a variety of subtle and seemingly disconnected sensory deficits which can be easily missed. Methods: Here we report a case of an 80 years ‘old Chinese female presenting sudden onset persistent sensory symptoms over perioral area and right hand. The patient underwent further investigation with Brain MRI. The patient underwent further investigation with Brain MRI. A literature review was conducted and the patient’s clinical finding was compared with the literature. Results: The patient’s presentation was consistent with clinical manifestation of type 1 Cheiro-Oral syndrome. Brain MRI performed the day after admission revealed small non-hemorrhagic infarction involving the left thalamus. The diagnosis was type 1 cheiro-oral syndrome secondary to left thalamic ischemic stroke. Conclusions: This report highlights both clinical presentations of cheiro-oral syndrome and correlating clinical symptomatology with anatomic localization. It is important for physicians to recognize this rare condition with subtle presentations for complete work-up and definitive treatment.