Discussion: Reconsideration of TIA terminology and definitions.

Abstract

When a group of interested stroke neurologists assembled 2 weeks into the new millennium to discuss redefining TIA, it is doubtful that they had an inkling of what lay in store for them. Over the ensuing 2 days, and in a follow-up meeting 9 months later, the clinicians grappled with the task of sorting out the evidence from conflicting data and then articulating a rationale for changing key clinical terms and ultimately the traditional definition of TIA. The debate sometimes turned contentious, and consensus was often elusive. But what emerged, after more than 2 years of a process that extended beyond face-to-face meetings into an ongoing electronic dialogue, may have ramifications for the management of cerebrovascular disease for the future Based on the premise that recent basic and clinical research as well as practical experience was challenging the traditional concept of TIAs, neurologic basic scientists, clinical researchers, clinicians, and health-care industry personnel met January 14–15, 2000. They reviewed and discussed recent investigations of TIAs and sought to frame an updated consensus view of TIA pathophysiology, diagnosis, and management. Over 2 days, clinicians presented recent research in animal models of cerebral ischemia, epidemiology of TIAs, neuroimaging, and data from two nationwide surveys on public awareness of and physician attitudes about TIAs. After the presentations, the participants addressed a number of concerns in wide-ranging discussions. Among the concerns were evidence or indications of the following: