Idiopathic hypertrophic cranial pachymeningitis (IHCP) is a very infrequent disorder that causes a localized or diffuse thickening of the dura mater. The main clinical features of IHCP at presentation are headache, cranial nerve involvement, ataxia, and seizures. Transient ischemic attacks (TIAs) have not previously been reported as a main clinical manifestation. We present a case with TIA as the main clinical manifestation and investigated the treatment of the case.