Transient ischemic attack (TIA) is part of the ischemic stroke spectrum and is a medical emergency. Urgent diagnosis and treatment are required because it is estimated that the risk of stroke after TIA may be as high as 10% at 7 days and 15% at 30 days. Furthermore, of patients who have a stroke within 90 days of TIA, 50% occur within 48 hours. The definition of TIA has evolved based on the development of advanced neuroimaging techniques. A new definition of TIA has been proposed and takes into account the brevity of spells (<60 minutes in duration) and absence, for example, of ischemic tissue damage on diffusion-weighted magnetic resonance imaging (MRI). A validated prediction tool, the ABCD2 score, provides guidance for the clinician in relation to the immediate risk of stroke after a TIA. Rapid assessment TIA and minor stroke clinics have been shown to substantially reduce the risk of stroke and provide other benefits. The National Stroke Association (NSA) and American Heart Association/American Stroke Association (AHA/ASA) evidence-based guidelines are recommended for the diagnosis and treatment of TIA. A key goal in the management of TIA is to define the underlying pathophysiologic stroke mechanism and then tailor preventive therapy according to evidence-based guidelines. Collaboration of primary care physicians, vascular neurologists, general neurologists, and other health care providers is essential to assure successful outcomes in TIA patients.