ORIGINAL ARTICLE Clinical skills or high-tech MR in TIA patients: what makes the difference? Riccardo Altavilla 1 & Sabrina Anticoli 2 & Michele Pellizzaro Venti 1 & Monica Acciarresi 1 & Andrea Alberti 1 & Valeria Caso 1 & Cataldo D’Amore 3 & Francesca Romana Pezzella 2 & Michele Venti 1 & Giancarlo Agnelli 1 & Maurizio Paciaroni 1 Received: 27 April 2018 /Accepted: 21 August 2018 # Springer-Verlag Italia S.r.l., part of Springer Nature 2018 Abstract Background TIA has been recently re-defined as Ba transient episode of neurological dysfunction caused by ischemia without acute infarction.^ The gold standard to exclude the presence of ischemic lesions is acute brain MR. However, in many clinical settings, the 24/7 availability of MR is, at best, irregular. Being so, an appropriate adoption of this definition, which excludes the presence of ischemic lesions, can only be equally irregular. Our aim was to retrospectively compare the long-term outcomes of patients receiving acute care for TIA diagnosed with the new, tissue-based definition, and those diagnosed only on symptom duration. Methods We analyzed 480 patients (227 males) from two centers: group 1 consisted of 162 patients with time-defined TIA; group 2 of 315 patients with negative brain DW-MRI (tissue-based TIAs). We considered the combined recurrence of TIA, stroke, myocardial infarction, and angina as endpoints. Results Both groups had a similar mean follow-up duration (38.3 months vs. 37.2 months) and were comparable for vascular risk factors, clinical features, and etiology. The combined endpoint rates were 11.1% for both groups, and the rates for segregate endpoints did not differ between groups. Recurrence was correlated with atrial fibrillation, diabetes, and high diastolic blood pressure. Conclusions The long-term outcomes of TIA patients did not differ according to the definitions applied. Therein suggesting that, even without acute MRI results, a clinical diagnosis seemed to be enough to assure prompt medical treatment and similar long- term outcomes. Keywords Transient ischemic attack . Diffusion-weighted magnetic resonance Introduction TIA, when considered Ba transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia,^ is generally treated as a medical emergency. In fact, SOS-TIA Network [1] has shown that urgent clinical workup and immediate therapeutic strategies in the face of a suspected TIA are the most determining factor in safeguarding post-TIA outcome, reducing recurrence of stroke at 90 days. In 2009, the American Heart Association/American Stroke Association (AHA/ASA) recommended that TIA be consid- ered Ba transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction^ [2]; this was justified by recent advantages in ra- diological diagnosis, because the high sensitivity of diffusion- weighted magnetic resonance imaging (DW-MRI) can reli- ably evidence TIAs without brain infarction from minor strokes with brain ischemia that are clinically transient. To this end, an acute MR is required within 24 h from symptom onset to determine the absence of acute infarction. However, in many emergency settings, the 24/7 availability of MR is at best irregular due to cost issues. Moreover, there are no known predictive clinical factors suggesting the presence of MR- * Riccardo Altavilla riccardoaltavilla@yahoo.it 1 Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Piazzale Menghini 1, 06129 Perugia, Italy 2 Stroke Unit, San Camillo Forlanini Hospital, Rome, Italy 3 Neurology – Stroke Unit, AULSS 4, Treviso, Veneto Orientale, Italy Neurological Sciences https://doi.org/10.1007/s10072-018-3546-4