A healthy 19–year–old man with no risk factors presented with focal neurological symptoms (dysphasia and right hemiparesis) in the setting of an acute febrile illness and severe cough. Initial CTs showed pan–sinusitis and pulmonary infiltrates. The cerebrospinal fluid was normal. Human coronavirus OC43 was identified in nasal swabs. Repeat CTA/MRA revealed multiple infarcts in the territory of the left middle cerebral artery (MCA) and proximal intra–luminal left internal carotid artery filling defects due to thrombi were demonstrated. No thrombophilia was found and there are no reports of sinusitis–associated carotid thrombosis in the literature. Recent infection, in particular respiratory infection is a confirmed risk factor of ischemic stroke (IS) in adults and intriguingly, also in young patients. Myriad mechanisms have been demonstrated or postulated in the very young and our report suggests adding carotid thrombi. Previously described cough–induced carotid dissection could not be demonstrated, but similarly, cough–induced intimal injury of the carotid artery remains the most likely culprit, precipitating local thrombus formation and embolization.