1. 55-year-old man presented with acute onset left side weakness. 2. Medical history includes atrial fibrillation, previous stroke, hypertension, hypothyroidism and dilated cardiomyopathy. 3. Workup revealed a thrombus in the left atrial appendage. The patient underwent intravenous tissue plasminogen activator and intra-arterial thrombectomy, with significant neurologic improvement.