Background and Purpose: Intravascular lymphoma (IVL) is characterized by the proliferation of lymphoma cells within small blood vessels. Diagnosis of IVL is difficult, and neurologic manifestations of the disease are common. Currently, there is little information related to the clinical course and rehabilitation of patients with IVL. This case report describes the presentation and treatment of an individual with IVL presenting as recurrent strokes. Case Description: A 53-year-old man was admitted for treatment of bilateral multifocal infarcts in cerebral watershed areas. Initial assessments indicated that he required minimal assistance for functional activities, and he was discharged home with outpatient services. He was readmitted 7 days later with worsening confusion, left hemiparesis, and deteriorating functional mobility. Rehabilitation team concerns related to the patient's progressive functional decline led to additional testing, resulting in a diagnosis of IVL. Outcomes: The patient initially required relatively little assistance with most functional activities, scoring 23 to 24/24 and 21/24 on the Activity Measure for Post-Acute Care (AM-PAC) Basic Mobility and Daily Activity Scales, respectively, 46/56 on the Berg Balance Scale (BBS), and 19/30 on the Montreal Cognitive Assessment (MoCA). He was subsequently readmitted and demonstrated a rapid functional decline, as evidenced by AM-PAC and BBS scores of 7/24 and 6/56, respectively. Discussion: This patient presented with neurological deficits and an initial diagnosis of bilateral multifocal infarcts. Documentation of his progressive functional decline and decreasing AM-PAC and BBS scores facilitated interdisciplinary communication and led to additional diagnostic testing, resulting in a final diagnosis of IVL and appropriate medical intervention.