TIA is a huge dilemma in ED. It could be challenging from definition to workup to disposition, but recent article in clinics of north America, reviewed the pitfalls in diagnosis and disposition of patients with TIA. TIA is important because there is a chance of Stroke within 48 hours (5%). It is challenging because misdiagnosis of TIA reported among EPs could be up to 60% and disagreement among neurologist to diagnose TIA is between 42% to 86 %. Interestingly, Castle, James et al did a study on Agreement Regarding Diagnosis of Transient Ischemic Attack among Stroke-Trained Neurologists and result demonstrated “diagnosis of TIA is highly subjective diagnosis, even among stroke subspecialists”.