[Medical or chirurgical treatment in transient cerebral ischemia? (author's transl)]

When a physician is faced by a patient suffering from transient ischemic attacks, the diagnosis is almost invariably determined by the clinical history. It becomes necessary to eliminate certain other medical conditions including migraine, focal epilepsy and cardiac disorders. Once he is satisfied with the diagnosis of TIA, then he must consider whether to employ medical or surgical therapy or a combination of both. It must be recognized that TIAs are not benign events since more than 50 p. 100 of individuals who develop completed strokes will have antecedent TIAs. Identification of the pathogenetic mechanism becomes important in choosing the specific therapy. Where the origin of the attacks is clearly thromboembolic, secondary to atherosclerosis, surgical intervention may be appropriate if the lesion is readily accessible. However, consideration of surgery is also determined by the risk of post-operative stroke or death at the hands of less experienced surgeons. The risk of stroke in a patient who is having frequent TIAs may be reduced initially by utilizing anticoagulants for a limited period. Long-term medical therapy requires the use of anti-platelet agents which have been shown to have a more beneficial effect in preventing strokes in men. The evidence for protection in females is less satisfactory. Surgical treatment should be followed by long-term medical therapy since it is very unlikely that only one lesion is present in a high-risk patient. It is still clear that the best way to manage cerebro-vascular accidents is to prevent them. This requires education of the public, as will as physicians, with respect to risk factors and the value of various modes of therapy.