The antiangiogenic and immunomodulatory properties of thalidomide have led to its use and evaluation in refractory or relapsed multiple myeloma (MM). However, thalidomide use is associated with several side effects, although deep vein thrombosis and peripheral neuropathy are the most serious. The incidence of thrombosis after treatment with thalidomide ranges from 2% to 23%, but is higher among patients who also receive chemotherapy. Thromboembolic episodes are usually venous and may cause pulmonary embolism or even myocardial infarction and cerebral venous thrombosis. Arterial occlusion is rare, and the association between arterial thrombotic events and thalidomide is infrequent with only a few patients reported who developed arterial strokes on thalidomide. We describe a case of nonfatal thrombotic stroke occurring in a patient with relapsed MM treated with thalidomide.