Background The frequency of early stroke occurrence after transient ischemic attacks (TIAs) has been poorly studied. Aim This work aimed to determine the possible predictors of early ischemic stroke within 90 days of the first attack of TIA among Egyptians. Patients and methods A total of 80 patients presented with acute ischemic stroke or TIAs were recruited and were divided into group A, which included 40 patients presented with ischemic stroke preceded by TIAs within the last 3 months, and group B, which included 40 patients who had one or more TIAs and were asymptomatic for more than 3 months. All patients were subjected to the following: neurological assessment, laboratory investigations, cardiologic assessment, and brain imaging. Results Older patients were more liable to stroke occurrence after TIAs. Hospital admission during TIAs significantly reduced the risk of early stroke occurrence. Receiving medical treatment during TIAs significantly reduced the risk of early stroke occurrence. Hypertension was the only significant modifiable risk factor for early stroke occurrence. Multiple TIAs were significant predictors of early stroke recurrence. The rate of stroke occurrence was higher during the short-term follow-up, especially during the first week. Magnetic resonance diffusion changes were significant predictors of early stroke occurrence. Conclusions The main prognostic factors for early stroke occurrence after TIAs were age, hypertension, hospital admission, early medical treatment after TIAs, duration and frequency of TIAs symptoms, ABCD2 score, and positive findings in brain imaging.