Asterixis, firstly described in metabolic encephalopathies, may occur unilaterally in patients with various focal brain diseases. Although hardly localizing, most reported cases have showed a contralateral thalamic pathology; but Lesions in the medial frontal lobe, parietal lobe, brain stem, basal ganglia, insular lesions, may also cause unilateral asterixis. In this article, three cases of acute cerebral vascular event with unilateral or asymmetrical asterixis were described: first patient with left sided hemiparesis and asterixis that ultimately diagnosed as right thalamic hemmorrage; second patient with right sided hemiparesis and asterixis after acute left thalamic infarction and a patient with transient right sided weakness and bilateral asymmetrical asterixis secondary to a transient ischemic attack in left internal carotid territory.  We then provided a literature review of published similar cases to emphasize on asterixis as a focal neurological sign.