Cerebral microbleeds have acquired increased attention as a silent marker of small vessel disease that carries an increased risk of hemorrhage. The etiology is believed to be either hypertension or amyloid deposition. Here, we present a case with a patient whose transient focal symptom most likely was due to the occurrence of an acute microbleed, indicating that not all microbleeds are silent and that the cause of a transient ischemic attack is not always ischemic.