Purpose: To present an unusual case of a cervical rib as a cause of subclavian artery occlusion and thoracic outlet syndrome. Procedures: Case report Results: A 39-year-old female presented to the emergency room with a 2-day history of unilateral headache, facial tingling, and slurred speech, along with a 2-month history of left upper extremity weakness and coolness of the left hand. A stroke workup that included carotid duplex ultrasonography revealed findings suggestive of left subclavian occlusion, later confirmed on CT angiography. Neurologic workup suggested migraine, rather than ischemia, as the cause of headache; however, the subclavian occlusion prompted further investigation, including a chest radiograph that revealed bilateral cervical ribs. The patient was taken to surgery where her left cervical rib was excised and the chronically occluded left subclavian artery was found to have significant post-stenotic dilatation. Given that the chronic nature of her left upper extremity symptoms were not limiting, the decision was made to not undertake bypass. Recommendation was made to remove her right cervical rib prophylactically at a future date. Conclusions: Cervical ribs are a rare cause of vascular thoracic outlet syndrome, with compression leading to post-stenotic dilatation and symptoms of ischemia in the involved extremity.