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The risk of recurrent stroke after transient ischemic attack (TIA) is high. In the past 10 years, TIA has increasingly been recognized as a medical emergency. Health systems have adapted toward rapid evaluation, investigation, and secondary prevention in patients with presumed TIA and minor stroke, and the significant benefits in reducing recurrent stroke and mortality have been borne out in several landmark studies. Various scores have been developed and debated to better risk stratify patients with TIA for hospitalization or urgent referral. However, scoring systems face challenges in identifying all patients with high-risk etiologies such as atrial fibrillation and carotid stenosis, and therefore require further refinement before widespread use. Further challenges include the role of advanced imaging in TIA, and ensuring rapid access to specialist care for all patients. In the absence of definitive risk stratification methods, the authors conclude that all patients with suspected TIA and minor stroke should be assessed and treated on an urgent basis, ideally through rapid outpatient referral programs.