This case focused on a 32 year old male with sudden loss of consciousness while horseback riding with his family. A head CT was negative at arrival at an outside hospital and family did not note any seizure like movements, loss of bowel or bladder. Prior to his passing out he complained of feeling like his “eyes were crossed.” He had no history of seizures, head trauma, head surgery and had prior completed a course of amoxicillin for a sinus infection. An MRI showed acute bilateral thalamic infarcts with micro-hemorrhage in the right thalamic infarct area. He had a thorough work up which revealed a PFO which was closed without incident 6 months after the event.