Ischaemic stroke in persons with migraine may present with aura-like symptoms. In this case report a 42-year-old man with migraine with aura presented with a change in usual aura including visual loss and disorientation. A brain MRI revealed ischaemic stroke in precuneus compatible with these symptoms. We discuss the pathophysiology, the causes and the secondary prophylaxis in persons with migraine with aura and stroke.