The association between antiphospholipid antibodies (aPL) and venous and arterial thromboses has been well described. However the association between aPL and avascular necrosis has not been widely reported. We report the association of avascular necrosis with the primary anticardiolipin antibody syndrome in a patient with a history of hemiplegic migraine and cerebrovascular infarcts. This phenomenon appears to be secondary to hemostatic abnormalities associated with the presence of aPL.