Racemose neurocysticercosis (NCC) is a rare and aggressive form of parasitic infection that primarily involves the subarachnoid space. It can lead to serious complications such as hydrocephalus and ischemic stroke due to vasculitis. Early recognition of this condition is essential for preventing long-term neurological damage. This report discusses a case of a 68-year-old male who presented with sudden onset right-sided hemiplegia and facial palsy despite having no previous comorbidities. Imaging studies revealed extraparenchymal cystic lesions consistent with racemose NCC, leading to obstructive hydrocephalus and stroke. The patient was treated with a combination of albendazole, praziquantel, and dexamethasone. Following three weeks of therapy, he demonstrated marked clinical improvement and was subsequently discharged with instructions for follow-up care. This case highlights the critical need for timely diagnosis and management of racemose NCC to improve neurological outcomes. Prompt treatment using antiparasitic agents and steroids can play a pivotal role in facilitating recovery and minimizing complications. Recognizing racemose NCC as a potential cause of stroke and hydrocephalus in endemic areas is vital for early intervention and enhanced patient outcomes.