This case takes place in Nevada and involves a 65-year-old woman who suffered a stroke secondary to clot in the setting atrial fibrillation. Her past medical history included hypertension, hyperlipidemia, atrio-septal defect repair and obstructive sleep apnea which had been treated with a Pillar Procedure. 2-years ago she was diagnosed with atrial fibrillation with pulpmary vein isolation and ablation, and had subsequently been started on Coumadin by her cardiologist. The cardiologist performed a cardioversion and subsequently discontinued her anti-coagulation medication. She had a follow-up with cardiology 6-months after her diagnosis and it was noted that she had no recurrence of atrial fibrillation. 18-months later, the patient suffered a stroke secondary to clot developed in the setting of atrial fibrillation. She was administered TPA but experienced no meaningful resolution of her left sided paralysis. Of note, she developed mild hemorrhagic conversion secondary to the TPA. Her treatment records subsequent to the stroke indicate the patient has chronic atrial fibrillation. They also note the patient was not on anti-coagulation prior to the stroke and that it had been discontinued by her cardiologist. Presently, the patient has total left sided paralysis, speech impairment, and is wheelchair bound.