Topographical disorientation (TD) is rare, especially as a manifestation of transient ischemic attack. Here, we report a case of transient TD as a manifestation of cerebral ischemic attack. A 55-year-old male bus driver suffered from sudden inability to recognize familiar surroundings. He completely recovered from this within 12 hours, but suffered a second episode of TD 3 weeks later, in combination with visual agnosia and prosopagnosia. Cerebral magnetic resonance imaging and single-photon emission computed tomography showed a lesion that had recently developed in the right posterior cerebral artery, in addition to a previous lesion in the left occipital pole. His TD symptoms persisted after the second episode.