Paradoxical embolism is a relatively uncommon clinical condition. Only a few hundred cases have been reported in the literature.1 Despite sophisticated technological advances, it remains an under-diagnosed clinical entity.2 Blood clots formed either in the right side of the heart or in the venous circulation escape via an intra- or extra-cardiac right-to-left shunt into the systemic circulation. This results in an arterial embolism, hence the term paradoxical embolism. The condition can cause significant morbidity and mortality. We report a case of cerebral infarction secondary to paradoxical embolism. This is the first case to be reported in the literature with the unique and rare association of patent foramen ovale and pulmonary arteriovenous malformation with hereditary haemorrhagic telangiectasia.