This review article summarizes recent advances in the care of patients presenting with neurologic events, in which transesophageal echocardiography plays an important role in diagnosis, prognosis, and treatment. New research on the use of transesophageal echocardiography in patients with stroke and atrial fibrillation is discussed, including left atrial clot formation, maintenance of sinus rhythm after cardioversion, and techniques of left atrial appendage occlusion. A discussion of developments in the diagnosis and management of thoracic aortic plaque follows. The association of patent foramen ovale and atrial septal aneurysm with stroke is outlined, and possible reasons for this association are discussed. Recent literature on the use of percutaneous closure devices for patent foramen ovale is reviewed.