Clinical evaluation and management of transient ischemic attacks.

Transient ischemic attack (TIA) is a common but poorly understood disorder. Although it rightfully has been classified as a major risk factor for stroke, the majority of patients with TIAs do not suffer subsequent stroke, and it is unclear whether aggressive evaluation and treatment of TIA will significantly lower stroke risk. To effectively treat this disorder, the implications of transient cerebral ischemia and the basic pathophysiologic process underlying this condition must be understood, as well as the myriad of specific clinical causes that must be considered in any patient. Any less sophisticated approach will only propagate the confusion that already exists and lead to the use of therapies that may be useless or even harmful.