To define practice patterns in the management of transient ischemic attacks (TIAs), we surveyed practicing neurologists attending an educational conference in San Francisco, evaluating management decisions in 2 TIA case vignettes. In a vignette describing a hemispheric TIA 1 day prior with ipsilateral bruit, 53% chose admission, 47% elected an outpatient work-up, 28% treated with intravenous heparin and 70% chose aspirin, reflecting the disagreement about medical management of carotid stenosis in the literature. There was more agreement in the second case, a posterior circulation TIA 1 day prior with atrial fibrillation, in which 84% chose hospital admission, 74% chose intravenous heparin and 90% treated with some form of anticoagulation. There are areas of important practice variability in the management of TIAs. Further research is justified to guide patient care decisions in TIA patients.