A 52-year-old man with paroxysmal atrial fibrillation presented with spontaneous confabulation, working memory deficits, and frontal release signs. MR scan of brain showed bifrontal mesial ischaemic strokes and angiography demonstrated that both anterior cerebral arteries were supplied by the left internal carotid artery. Isolated spontaneous confabulation is a rare presentation of stroke and may be associated with orbitofrontal cortex lesions. Interestingly, functional imaging during rapid-eye-movement sleep may show bilateral medial frontal lobe hypometabolism, suggesting anatomical overlap between dreaming and the bizarre content of this patient's spontaneous confabulation.