Snapshot A 55-year-old woman presents to the emergency department after developing slurred speech approximately 2 hours ago. Once she arrived, her symptoms gradually resolved. CT head without contrast and CT angiography was unremarkable. MRI brain with diffusion weighted sequences does not provide evidence of ischemia. An electrocardiogram demonstrates an irregularly irregular rhythmn with absence of P-waves, concerning for atrial fibrillation. She was admitted for an expedited work-up, which demonstrate left atrial dilation on transesophageal echocardiography. Introduction Definition a transient focal neurological deficit without acute infarction Epidemiology Risk factors hypertension hyperlipidemia cigarette smoking cardiac arrhythmias metabolic conditions metabolic syndrome and diabetes chronic kidney disease Etiology Cryptogenic (no clear source) Atheroemboli Vertebral artery stenosis Cardiogenic emboli seen in cases of arrhythmias Hypercoagulable/hyperviscious states (e.g., leukemia and sickle cell disease) Presentation Symptoms/physical exam clinical presentation depends on the location where the transient ischemic attack occured e.g., amaurosis fugax when the ophthalmic artery is involved Imaging MRI brain indication preferred imaging modality in patients with a suspected TIA obtain with diffusion-weighted images Intracranial non-invasive vessel imaging indication helps in determining the cause of the TIA modalities MR or CT angiography carotid ultrasound transcranial doppler Studies Electrocardiogram able to identify new arrhythmias Differential Acute ischemic stroke differentiating factors evidence of infarction is present on MRI Treatment Medical statin indication secondary stroke prevention antihypertensive treatment indication secondary stroke prevention in patients who are hypertensive antiplatelet treatment indication secondary stroke prevention in patients with non-cardioembolic TIA or stroke aspirin should be given immediately once bleed has been ruled out anticoagulation treatment indication secondary stroke prevention in patients with cardioembolic TIA or stroke Operative carotid endarterectomy indication in cases of TIA caused by cervical internal carotid artery stenosis (50-99%) who have a life expectancy of at least 5 years Compications Acute ischemic stroke Prognosis ABCD2 score a risk assessment tool that determines the risk of a stroke shortly after a transient ischemic attack (TIA) the higher the score, the higher the risk of developing a stroke Patients are at high risk for recurrent TIAs and developing stroke