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• Of 358 patients referred for evaluation of cerebral vascular insufficiency over a ten-year period (January 1971 to April 1981), 32 were isolated who had experienced hemispheric transient ischemic attacks (TIAs), and lacking other identifiable abnormality were found angiographically to be free of suspicious extracranial occlusive or ulcerated lesions. These patients were studied retrospectively to evaluate their prognosis in terms of cerebral infarction and recurrent neurologic symptoms. In a mean follow-up of 16 months, ranging from three months to four years, no patient suffered a cerebral infarction. Six had further symptoms; however, three were due to other abnormalities found subsequently. Three patients continued to be symptomatic; however, only one patient had recurrent hemispheric symptoms, the others being global and vague in description. Severe hypertension was associated with an increased risk of further attacks. The data indicate that the prognosis for patients with normal angiograms and hemispheric TIAs, lacking other identifiable abnormality, is good. ( Arch Surg 1981;116:1587-1591)