We discuss a case of an otherwise healthy 70 yo woman (past medical history significant only for rheumatic heart disease as a child) who presented with recurrent multifocal strokes in a two-week span. Her initial stroke resulted in acute left upper extremity weakness and she was discharged on xarelto 20mg and atorvastatin 80mg. A week and a half later, she reportedly woke up with vision changes and thought that objects “looked funny, like parts were missing” to the point that she was unable to even read the numbers on her phone to call 911 and had to rely on her neighbor. Neurologic exam was significant for simultagnosia (inability to see a bigger letter made of other smaller letters), lateral gaze ocular apraxia, and dysmetria on finger to nose testing due to ocular ataxia. MRI brain showed multifocal acute infarcts, most prominently in the right occipital lobe, right parietal lobe and bilateral frontal lobes. Initial stroke work-up including a TTE was unrevealing (EF 65%, no LA dilation), but follow-up TEE showed a 0.3mm x 0.5mm hypoechoic mass concerning for marantic endocarditis with negative blood cultures. The patient underwent PET imaging and subsequent biopsy of a right mediastinal lymph node. Final pathology revealed ER/PR+, Her2- metastatic breast cancer. She was started on letrozole 2.5 mg daily for chemotherapy and was discharged with close follow-up.