A 72-year-old man with baseline vascular dementia was admitted for 3 days of confusion, unintelligible speech, and incontinence. His past medical history was notable for a right middle cerebral artery territory infarction 4 years prior, coronary artery disease treated with angioplasty and stenting, hypertension, and diabetes. Upon evaluation in our emergency department, his examination was notable for expressive aphasia and confusion. He was moving all extremities spontaneously against gravity. A noncontrast head CT was performed that showed a subacute infarct in the left frontal lobe, subsequently confirmed on MRI (panel A). Since he was outside the window for thrombolysis and intervention, he was given one full-dose aspirin (325 mg tablet), and admitted to our hospital for a stroke evaluation.During the course of his stroke work-up, he was found to have an apical left ventricular thrombus, presumably the etiology of his subacute left frontal lobe infarct. Given his increased risk of further ischemic strokes, he was started on anticoagulation 7 days after his stroke using intravenous heparin and then switched to an oral vitamin K antagonist (warfarin).