Objective: Although this is an understudied population, low educated patients with moderate to severe traumatic brain injuries suffer profound functional losses due to their limited skill sets (i.e., generally limited to manual labor). When a stroke follows a head injury, the consequences are severe, permanent disability. A review of the literature suggests that the incidence of stroke following head injury is rare. Method: We present the case of a monolingual Spanish-speaking Latino who developed a severe head injury with multiple orthopedic fractures after a 25–30 foot fall, and then experienced a right middle cerebral artery infarct while in the Emergency Room, resulting in right hermiparesis, profound left hemineglect, anosognosia, and behavioral difficulties. Data from neuroimaging studies, two neuropsychological evaluations and follow up treatment over four years are presented. Neuropsychological instruments in Spanish with appropriate norms were used and are compared across time. Visuospatial skills were notable for hemispatial neglect but improvement over time was noted as he implemented compensatory strategies. Other impairments were noted in his attention, executive functions, and processing speed. Verbal skills and memory remained intact. Conclusions: Findings showed consistent lateralized findings across time, with pervasive impairments. He experienced marginal improvements in his hemispatial neglect over four years. While his lack of awareness guarded him against hopelessness, and provided an impetus for his effort in ancillary therapies, it also contributed to his constant conflict with other patients, families and clinicians, attributing his aggression to the motives of others. Cultural issues and their influence on family involvement in patient care are discussed.