Transient Ischaemic Attack

Last updated: 13 Aug 2025

This article provides an overview of Transient Ischaemic Attack (TIA), with a specific focus on its implications for older adults living with Type 1 Diabetes.

What is TIA?

A Transient Ischaemic Attack, commonly referred to as a “TIA” or “mini-stroke,” is a temporary interruption of blood flow to a specific part of the brain, spinal cord, or retina (the light-detecting layer at the back of the eye). This disruption leads to a transient lack of oxygen and nutrients in the affected brain tissue, a state known as ischaemia, which triggers symptoms that mimic a full stroke.

The blockage is typically caused by a small blood clot that has formed elsewhere in the body (often in the heart or large arteries of the neck) and traveled to the brain. In other cases, the blockage can be caused by fragments of fatty deposits (plaques) that break off from an artery wall or, more rarely, by air bubbles. The defining characteristic of a TIA is that this blockage is temporary; the clot dissolves or moves on its own, and blood flow is restored before any permanent damage occurs.

In simple terms, this means the event causes temporary symptoms without leaving behind an area of dead brain tissue, which is the hallmark of a major ischemic stroke.

Why a TIA is a Critical Medical Emergency and a Warning Sign

Despite the transient nature of its symptoms, a TIA must be treated as a major medical emergency. It serves as a powerful and urgent warning that a person is at extremely high risk of having a full stroke.

About one-third of individuals who experience a TIA will go on to have a major stroke. Critically, about half of these post-TIA strokes occur within the first 48 hours.

Acting F.A.S.T

Prompt recognition of TIA symptoms is essential for seeking immediate medical care. The F.A.S.T. acronym is a simple tool for remembering the most common signs:

• Face drooping
• Arm weakness
• Speech difficulty
• Time to call 000 (or 112 outside of Australia)

Beyond F.A.S.T: Other Symptoms to Watch For

While the F.A.S.T. test identifies the majority of TIAs and strokes, other symptoms can also occur. These include:

• Visual Disturbances: Sudden loss of vision, blurred vision, or double vision in one or both eyes.
• Balance and Coordination Problems: Sudden dizziness, a feeling that the room is spinning (vertigo), difficulty walking, or a loss of balance and coordination. -Numbness or Weakness: Sudden numbness or weakness that can affect a leg or, in some cases, cause complete paralysis on one side of the body.
• Cognitive Difficulties: Sudden confusion, trouble understanding what others are saying, or difficulty with reading or writing.
• Severe Headache: A sudden and unusually severe headache that has no obvious cause.

Potential for Misdiagnosis in people living with T1D

Other medical conditions can produce transient neurological symptoms that “mimic” a TIA. For an older adult living with Type 1 Diabetes, the most common mimic is hypoglycemia (low blood sugar). The symptoms of hypoglycemia (including confusion, weakness, dizziness, and slurred speech) can be nearly identical to those of a TIA. Other common mimics include migraine with aura and certain types of seizures.

The diagnostic picture for an elderly person with Type 1 Diabetes is uniquely complex. The constant potential for hypoglycemia means that any TIA-like symptom could potentially be due to low blood sugar. To make matters more difficult, the classic warning signs of hypoglycemia (like shakiness or sweating) can become blunted with long-standing diabetes, making the brain-related symptoms like confusion and weakness more easily mistaken for a stroke.

This chameleon nature of TIA in the presense of T1D underscores the importance of the “Time” component of F.A.S.T. It is not just time to call for help, but also time to gather crucial information. If it can be done quickly and safely, checking a blood glucose level can provide invaluable insight for emergency responders. However, it is vital to understand that even if symptoms resolve after treating a low blood sugar, a full medical evaluation is still essential. A severe hypoglycemic event can itself be a physiological stressor that may trigger a true vascular event.

The Impact of Long-Term Type 1 Diabetes on Vascular Health

The presence of diabetes dramatically increases the risk of TIA and stroke.

See the Vascular Health article for more detail regarding the risks and changes to vascular health associated with aging with T1D.

What to expect after after a suspected TIA

Because a TIA is a powerful predictor of an imminent stroke, the diagnostic process is urgent and thorough. The goal is not simply to confirm that a TIA occurred (as the symptoms are often gone by the time of evaluation) but to conduct a comprehensive investigation to determine the underlying cause and to prevent a future stroke.

Diagnosis

The evaluation for a suspected TIA should begin as soon as possible, ideally in a hospital emergency department. The initial steps involve:

• Medical History and Examination. The assessing clinician will ask for a precise account of the event. They will want to know exactly what symptoms were experienced, when they started, how long they lasted, and whether anything like this has happened before. A comprehensive exam is performed to assess cardiovascular andneurological function. This includes examination with a stethoscope and tests of vision, eye movements, strength, sensation, reflexes, balance, coordination, and speech.
• Medical Imaging (Brain and artery scans)
• ECG and Echocardiogram
• Blood tests. A panel of blood tests is a standard part of the TIA evaluation. These typically include a complete blood count, cholesterol and lipid levels, and tests of blood clotting function.For an older adult with Type 1 Diabetes, the most critical immediate blood test is a blood glucose measurement. This is done to definitively rule out hypoglycemia as the cause of the symptoms and to assess for hyperglycemia, which is a known risk factor.

Treatment and Prevention

The treatment following a TIA is not aimed at the TIA itself, but is focused on aggressive secondary prevention to reduce the high risk of a future stroke. For an older adult with Type 1 Diabetes, this involves a multi-pronged approach that combines medication, potential surgical procedures, crucial lifestyle changes, and a highly personalised strategy for glycemic control.