Thrombotic thrombocytopenic purpura (TTP) is an episodic microangiopathic coagulopathy characterized by profound thrombocytopenia and hemolytic anemia. Neurovascular complications, including stroke and TIA, occur commonly upon initial TTP presentation, and the underlying etiology of such neurologic manifestations is usually hinted by the concomitant hematologic abnormalities. These neurologic manifestations may present long before the hematological disturbances may manifest clinically and hence a high degree of suspicion is necessary for diagnosis. We present here such a case of TTP presenting with a Transient Ischemic Attack (TIA).