An ascending aortic thrombus is a rare source for embolic transient ischemic attack (TIA) or stroke without an associated aortic pathology. Here we describe a case of a patient who presented with generalized symptoms of headache and fatigue who, on subsequent work-up , was found to have an ascending aortic thrombus with no obvious associated aortic pathology, and was successfully treated with apixaban, a newer direct oral anticoagulant.