Objective To analyze the clinical characteristics, diagnosis and treatment of cerebral embolism from brachiocephalic artery thrombosis. Methods A case was reviewed with literature. Results Acute multiple cerebral infarctions were found in both right anterior and posterior circulation. Arterial floating thrombi with cyclic motion relating to cardiac cycles was found with transthoracic Doppler ultrasonography.Anticoagulation therapy played the major role in treatment. Conclusion Transthoracic Doppler ultrasonography is recommended in the suspicion of patients with typical clinical presentations in order to investigate the vascular conditions in the brachiocephllic trunk, and anticoagulation therapy should be initiated immediately after the thrombi have been detected.