A 40-year-old male presented with a 3-week history of multiple transient focal neurological events. On the first occasion, he woke up with left-sided weakness and incoherent speech lasting for a few minutes. This was followed within a few days by episodes of right hemiparesis and expressive dysphasia lasting up to 30 minutes. These symptoms were associated with a constant occipital headache, worse towards the end of day, which was helped with analgesia. He had no relevant past medical history and had never smoked. On examination, his blood pressure was 135/85 mmHg. He had minimal ataxia on...

A 40-year-old male presented with a 3-week history of multiple transient focal neurological events. On the first occasion, he woke up with left-sided weakness and incoherent speech lasting for a few minutes. This was followed within a few days by episodes of right hemiparesis and expressive dysphasia lasting up to 30 minutes. These symptoms were associated with a constant occipital headache, worse towards the end of day, which was helped with analgesia. He had no relevant past medical history and had never smoked. On examination, his blood pressure was 135/85 mmHg. He had minimal ataxia on heel–toe walking, but his neurological examination was otherwise normal.