Transient ischaemic attacks. Current treatment concepts.

Transient ischaemic attacks are common, having an incidence of at least 50 per 100,000 population per annum, and the risk of stroke and/or death is about 10% per annum. Death is more often due to the complications of coronary artery disease than cerebrovascular disease. The most important issues in management are distinguishing transient ischaemic attacks from several other causes of 'transient focal neurological attacks', and managing the risk factors for vascular disease in general, particularly hypertension. The utility of specific 'antithrombotic' treatments is still uncertain, but for long term use aspirin seems to be the most promising. The only dose so far tested in clinical trials has been about 600mg twice daily but lower doses may theoretically be as, or more, effective. Trials of aspirin and other antiplatelet agents, and also of carotid endarterectomy and extracranial-to-intracranial bypass surgery are continuing and should be strongly encouraged. Although transient ischaemic attacks recover - by definition - in 24 hours, the pathophysiology, natural history, and treatment of focal cerebral ischaemia which recovers in a matter of days or weeks is probably rather similar.