Temporal profile resembling TIA in the setting of cerebral infarction

Abstract

It seems prudent to us to reserve the term TIA to describe episodes of focal deficit which resolve completely within 24 hours, in which the purported brain lesion is one of an ischemic nature, and which on CCT (computed cranial tomography) leaves no visible evidence of its presence. A separate and specific category, cerebral infarction with transient signs (CITS), might appropriately be used to describe patients who (i) fit the temporal profile of TIA but (ii) in whom there is evidence for infarction on CCT. It should be emphasized that this category is an operational one, since the accuracy of diagnosis of structural cerebral lesions is improving with the development of new generation CCT scanners, positron emission tomography, and nuclear magnetic resonance, and may vary from center to center. CCT is only one of a number of laboratory tests that can demonstrate structural pathology, and it is likely that other tests will in the future be widely available. Nevertheless, this distinction may prove useful for the diagnosis and study of patients with cerebrovascular disease, because it may permit the explicit differentiation of one type of transient neurological dysfunction with a well-defined basis in terms of parenchymal pathology. While it is unlikely that transient episodes of neurological dysfunction due to cerebral infarctions represent a single pathophysiological entity, it may be important to place patients with such episodes in a different diagnostic category from those with TIA, since this categorization may have important implications for prognosis and therapy.