Physicians in the Emergency Department were the first to see Mr. C. Our job was to figure out why he could not talk clearly at breakfast. Before making a tentative diagnosis of TIA, we would consider a differential of other conditions that could present in this fashion. A detailed history from the patient and his wife would rule out a more chronic mental status change, head trauma, or side effects of medications. Bedside evaluation would determine blood sugar levels, and pulse oximetry detect any hypoxia. We would also look for some indication of generalized hypotension or cardiac arrhythmia, which might have reduced overall systemic blood flow and contributed to his symptoms. If our initial work-up suggested the diagnosis of a TIA, we would request a consult with a neurologist to help guide Mr. C's further evaluation.