Levetiracetam (LEV) is a widely used second-generation antiepileptic drug with a generally favorable safety profile. Autonomic adverse effects, including urinary and fecal incontinence, are rarely reported, especially in younger adults. We report the case of a 47-year-old man with newly diagnosed hypertension who presented with an acute ischemic stroke and subsequently developed focal seizures treated with levetiracetam. Three months after discharge, he experienced daily urinary and fecal incontinence without concurrent seizures, cognitive impairment, metabolic disturbances, or new neurological deficits. Electroencephalography revealed no epileptiform activity. Given the temporal association with LEV initiation and the absence of alternative explanations, LEV-induced autonomic dysfunction was suspected. Discontinuation of LEV and initiation of valproic acid led to complete resolution of symptoms. This case underscores a rare but reversible autonomic adverse effect of levetiracetam and highlights the importance of clinical vigilance, particularly in patients with underlying cerebrovascular disease.