A transient ischemic attack is an acute neurologic event caused by focal ischemia affecting the brain, eye, or spinal cord, resolving quickly without infarction on magnetic resonance imaging (MRI) diffusion-weighted imaging (DWI). It is a tissue-based diagnosis, highlighting the need for prompt recognition and risk stratification. Evaluation in the emergency department includes detailed history, risk assessment, neurologic examination, and initial noncontrast computed tomography (CT) to rule out other conditions, with MRI DWI as the gold standard for confirming no infarction. Vascular imaging, echocardiography, electrocardiogram (ECG), and laboratories help identify underlying causes. Central retinal artery occlusion (CRAO) requires urgent diagnosis and ophthalmology consultation to prevent permanent vision loss.