Dear Sir,

The authors of a recent article on thrombolytic therapy [1] advocate revising the definition of transient ischemic attack (TIA) based on recent advances in brain imaging. There have been several serious attempts to do this since the original description by Miller Fisher in 1958 [2], including that by a distinguished US neurological group in 2002 [3] but none have withstood the ordeal of the test of time. The task is made all the more difficult by continuing advances in imaging over the years, so the definition would need to change from year to year.

Stroke and TIA were purely clinical definitions made decades before imaging was available, and so will never change in the foreseeable future. Progress in brain imaging will need to adapt accordingly and not the other way round.



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  2. References
  • 1
    Alonso de Lecinana M, Fuentes B, Masjuan Jet al. Thrombolytic therapy for acute ischemic stroke after recent transient ischemic attack. Int. J. Stroke 2012; 7:213218.
  • 2
    Fisher CM. Intermittent cerebral ischemia; in Wright JS , Millikan CH (eds): Cerebral Vascular Disease. New York, Grune and Stratton, 1958:8197.
  • 3
    Albers GW, Caplan LR, Easton JDet al. Transient ischemic attack – proposal for a new definition. N Engl J Med 2002; 347:17131716.