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A 57-year-old white woman, with history of hydatidiform mole 2 years earlier, was evaluated at our stroke center for the acute onset of intense cephalgia, vomiting, and aphasia. Recent medical history was significant for a vertebrobasilar transient ischemic attack 1 month earlier with a negative etiologic evaluation and negative vessel imaging and transesophageal echocardiography (TEE). A treatment by aspirin 160 mg was then started. On admission, neurological examination revealed a global aphasia and right homonymous hemianopsia. The National Institutes of Health Stroke Scale score was 8. She had no fever. Cardiovascular examination revealed a systolic murmur. Pulmonary auscultation was normal. A computed tomographic brain scan showed a left lobar temporal intracerebral hematoma with a subarachnoid hemorrhage in the ipsilateral sylvian fissure. Cerebral angiography and arteriography showed no vascular abnormality. Brain MRI showed a hemorrhagic infarction in the left middle cerebral artery territory and revealed several subacute infarctions in other vascular territories (Figure 1). Magnetic resonance angiography was normal. Coagulation tests involving fibrinogen, prothrombin time, activated partial thromboplastin time were normal. …