A 26-year-old right-handed female with an anaplastic astrocytoma of the left insula presented with the right pronator drift [Figure 1]. A medical history was significant for prior tumor resection 6 years ago and tumor-associated epilepsy. On preoperative evaluation, she was noted to have right hemiparesis graded at 4/5, mild right pronator drift, emotional lability, and impaired attention. Following surgery, postoperative imaging was obtained [Figure 1]. Before cTBS administration, physical therapy evaluation demonstrated delayed coordination, decreased strength of the left lower extremity, right facial droop, and a postoperative change in vision from normal and midline to diminished (reported: "blurry") in the left eye. The patient's right hemiparesis and mild right pronator drift were unchanged from preoperative evaluation. Medications affecting seizure threshold that were given during a patient's hospital course are listed with dosage and time of administration when applicable in [Table 2]. Of note, patient 1 continued her home dose of levetiracetam and did not receive a loading dose or any additional antiepileptic medications with exception of a dose administered intraoperatively before direct cortical stimulation.