A 37-year-old man was brought to the emergency department (ED) after he had 2 near-syncopal events. The first occurred in the morning and rapidly resolved; the second occurred later in the day at work. The night before he had a headache and neck pain. In the ED, he reported left arm and leg weakness and was noted to have left facial droop.

A 68-year-old woman with a history of hypertension, hyperlipidemia, and tobacco use presented with her third stroke in the past 7 years. Neurological deficits included dysarthria and left-sided motor and sensory loss. A previous transthoracic echocardiogram with a bubble study did not reveal any cardiac source of embolism. Axial MRI of the brain on admission showed an abnormal signal in the bilateral hemispheres representative of multiple subacute infarcts

A 59-year-old woman had aphasia and right-sided weakness after a routine total knee replacement. CT and MRI scans revealed a large left middle cerebral artery infarct. A CT angiogram showed no significant disease of the cerebrovascular arteries. Test results for the lupus anticoagulant were positive. A venous study of the legs showed no deep venous thrombosis. She was treated with warfarin and aspirin and discharged. After speech and physical therapy, she had mild residual aphasia.