Send to

Choose Destination
Front Neurol. 2017 Oct 18;8:537. doi: 10.3389/fneur.2017.00537. eCollection 2017.

Optimizing the Definitions of Stroke, Transient Ischemic Attack, and Infarction for Research and Application in Clinical Practice.

Author information

Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
The Neurology Department, The Alfred Hospital, Melbourne, VIC, Australia.
Neurological Clinic, Marche Polytechnic University, Ancona, Italy.
Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria.
Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia.
Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, QLD, Australia.
Cerebrovascular Program, Neurology Service, Department of Medicine, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana - Universidad del Desarrollo, Santiago, Chile.
Department of Vascular Surgery, University Medical Centre of Utrecht, Utrecht, Netherlands.
Department of Neurosurgery, Penn State University, State College, PA, United States.
Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom.
Department of Medicine, Elderly Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
Department of Neurology, Miller School of Medicine, Miami, FL, United States.
Imperial College Healthcare NHS Trust, London, United Kingdom.
Imperial College, London, United Kingdom.
Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College School of Medicine, Charing Cross Hospital, London, United Kingdom.
Department of Radiology, Alfred Health, Melbourne, VIC, Australia.
Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, UK Dementia Research Institute at the University of Edinburgh, Edinburgh, United Kingdom.


Background and purpose:

Until now, stroke and transient ischemic attack (TIA) have been clinically based terms which describe the presence and duration of characteristic neurological deficits attributable to intrinsic disorders of particular arteries supplying the brain, retina, or (sometimes) the spinal cord. Further, infarction has been pathologically defined as death of neural tissue due to reduced blood supply. Recently, it has been proposed we shift to definitions of stroke and TIA determined by neuroimaging results alone and that neuroimaging findings be equated with infarction.


We examined the scientific validity and clinical implications of these proposals using the existing published literature and our own experience in research and clinical practice.


We found that the proposals to change to imaging-dominant definitions, as published, are ambiguous and inconsistent. Therefore, they cannot provide the standardization required in research or its application in clinical practice. Further, we found that the proposals are scientifically incorrect because neuroimaging findings do not always correlate with the clinical status or the presence of infarction. In addition, we found that attempts to use the proposals are disrupting research, are otherwise clinically unhelpful and do not solve the problems they were proposed to solve.


We advise that the proposals must not be accepted. In particular, we explain why the clinical focus of the definitions of stroke and TIA should be retained with continued sub-classification of these syndromes depending neuroimaging results (with or without other information) and that infarction should remain a pathological term. We outline ways the established clinically based definitions of stroke and TIA, and use of them, may be improved to encourage better patient outcomes in the modern era.


asymptomatic carotid stenosis; infarction; public health practice; stroke; transient ischaemic attack

Supplemental Content

Full text links

Icon for Frontiers Media SA Icon for PubMed Central
Loading ...
Support Center