The value of continuous long-term ECG monitoring in patients with transient generalized neurological symptoms is well established, but its value in transient focal neurological deficits is less clear. A patient is reported who had significant dysrhythmias and transient focal cerebral symptoms which did not clear after cardiac pacing. Nineteen other patients were monitored as part of their evaluation for transient focal cerebral symptoms and were found to have essentially no cerebrally significant dysrhythmias. This report suggests cardiac dysrhythmias rarely cause such symptoms.