Patients with prosthetic cardiac valves are at increased risk of developing cerebral embolism, which may be manifested as either transient ischemic attack (TIA) or stroke. TIA resolves completely within 24 hours, in contrast to the focal or global cerebral dysfunction of stroke, which lasts >24 hours and is often the cause of significant clinical sequelae, Transesophageal echocardiography (TEE) is considered most reliable in the detection of intracardiac embolic sources.(1-4) The present study investigates the differences between patients presenting with a first episode of TIA or stroke after mechanical prosthetic valve implantation, using transthoracic echocardiography (TTE) and TEE.