Transient ischemic attacks (TIA) are a common presentation to the emergency department (ED) and are associated with an estimated 9% risk of stroke within 90 days.1 We report the case of a 72-year-old female who presented with orthostatic symptoms of facial weakness and dysarthria; that is, the patient’s symptoms were present when she was standing and resolved when supine. Neurological deficits present only when standing should alert the clinician to the importance of advanced neuroimaging to evaluate for acute arterial occlusion.