Cerebrovascular Accidents represent a dangerous complication of cyanotic children with tetralogy of fallot with incidence of 8.6%.Tetralogy of Fallot has been associated with raised haematocrit with low arterial Saturation. Here we describe an 18 months old female child of Tetralogy of Fallot with Cyanotic spells acute onset right sided hemiplegia with Right Atrial thrombus who underwent emergency surgery with intraoperative predicament.