A 42-year-old man presented to the ED after experiencing multiple episodes of difficulty in speaking. Three years earlier, he had a DVT that was treated with anticoagulation. He had also sustained head trauma without loss of consciousness approximately 4 years earlier. The patient was a competitive bicyclist and maintained a rigorous training regimen. CT angiography of the head was unremarkable and MRA of the neck with contrast found no signs of stenosis, thrombosis, or dissection. MRI of the brain with contrast indicated a subacute infarct.