Although structural brain scans help assess brain injury in stroke, they cannot identify regions that are functionally disabled due to disrupted perfusion. Perfusion and functional MRI have the potential for determining the functional consequences of stroke. Here we examine the effectiveness of functional MRI to measure brain function in a single patient (LB) with chronic hypoperfusion. When LB made sustained hand movements we observed a sustained decrease in the fMRI signal, while normal individuals exhibit a sustained increase in signal while conducting this task. This work has clear implications for understanding stroke using functional MRI.