Central etiologies of bilateral vocal cord paralysis leading to respiratory stridor are uncommon, as they require bilateral disruption of the laryngeal motor fibers. Here we present a young woman with multiple vascular risk factors, including ischemic stroke in the right medulla occurring 3 months prior, who presented with acute inspiratory stridor. All respiratory parameters were normal including arterial blood gas, and neck and pulmonary imaging. Direct laryngoscopy showed bilaterally bowed vocal cords, with decreased mobility and paradoxical adduction with each inspiratory cycle. On the third hospital day, neurological signs including a right hemiparesis became evident. Brain magnetic resonance imaging showed a diffusion restriction in the left medial pons likely disrupting the laryngeal motor fibers to the ponto‐medullary neuronal network. In the absence of tracheobronchial obstruction, physicians should be alert to the central causes of stridor including ischemic stroke. Additionally, paradoxical movements of the vocal cords can be an ominous sign.