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Taheri S, Peters N, Zietz A, Abel B, Hubert G, Barinka F, Wiestler H, Kovacic I, Linker R, Schlachetzki F, Backhaus R. Clinical Course and Recurrence in Transient Global Amnesia: A Study From the TEMPiS Telestroke Network. J Clin Neurol 2023; 19:530-538. [PMID: 37455507 PMCID: PMC10622726 DOI: 10.3988/jcn.2022.0368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/17/2022] [Accepted: 03/07/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND AND PURPOSE While the clinical hallmarks of transient global amnesia (TGA) are well defined, its pathophysiological causes are poorly understood. Specifically, risk factors for recurrences are yet to be determined. METHODS This retrospective study analyzed TGA cases diagnosed and treated within the TEMPiS telestroke network and a university stroke center in Germany. Demographic and clinical data were assessed and characteristics of TGA episodes were recorded, such as season of occurrence, trigger factors, duration, and concomitant symptoms. Follow-up of the potential recurrence of TGA was performed using a standardized questionnaire. RESULTS Overall 109 patients were included (age 64±8 years [mean±SD], 59.6% female). The most common vascular risk factor was arterial hypertension (60.6%), and other concomitant conditions included migraine (11.9%), hypothyroidism (22.9%), and atrial fibrillation (4.6%). The most frequent concomitant clinical feature accompanying the TGA episode at admission was elevated blood pressure (48.6%). Nineteen patients experienced at least one recurrent TGA episode. Migraine and hypothyroidism were only observed in subjects with a single TGA episode without recurrence (migraine: 14.4% without recurrence vs. none in the recurrence group, p=0.02; hypothyroidism: 27.8% without recurrence vs. none in the recurrence group, p=0.009). In contrast, atrial fibrillation was more common in subjects with TGA recurrence (p<0.001). CONCLUSIONS Arterial hypertension is prevalent in TGA patients, with elevated blood pressure being the most-frequent concomitant condition. In our cohort, recurrence of TGA occurred in approximately one-fifth of patients. Concomitant conditions such as migraine, hypothyroidism, and atrial fibrillation occurred at different frequencies in the two groups.
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Affiliation(s)
- Shadi Taheri
- Stroke Center, Klinik Hirslanden, Zürich, Switzerland
- University of Basel, Basel, Switzerland.
| | - Nils Peters
- Stroke Center, Klinik Hirslanden, Zürich, Switzerland
- University of Basel, Basel, Switzerland
- Department of Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland.
| | - Annaelle Zietz
- University of Basel, Basel, Switzerland
- Department of Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland
| | - Berthold Abel
- Stroke Center, Klinik Hirslanden, Zürich, Switzerland
| | - Gordian Hubert
- Department of Neurology, TEMPiS Telemedical Stroke Center, München Klinik Harlaching, Munich, Germany
| | - Filip Barinka
- Stroke Center, Klinik Hirslanden, Zürich, Switzerland
- Department of Neurology, University of Regensburg, TEMPiS Telemedical Stroke Center, Medbo Bezirksklinikum Regensburg, Regensburg, Germany
| | - Hanni Wiestler
- Department of Neurology, TEMPiS Telemedical Stroke Center, München Klinik Harlaching, Munich, Germany
| | - Irena Kovacic
- Department of Neurology, University of Regensburg, TEMPiS Telemedical Stroke Center, Medbo Bezirksklinikum Regensburg, Regensburg, Germany
| | - Ralf Linker
- Department of Neurology, University of Regensburg, TEMPiS Telemedical Stroke Center, Medbo Bezirksklinikum Regensburg, Regensburg, Germany
| | - Felix Schlachetzki
- Department of Neurology, University of Regensburg, TEMPiS Telemedical Stroke Center, Medbo Bezirksklinikum Regensburg, Regensburg, Germany
| | - Roland Backhaus
- Department of Neurology, University of Regensburg, TEMPiS Telemedical Stroke Center, Medbo Bezirksklinikum Regensburg, Regensburg, Germany
- Swiss Clinical Neuroscience Institute, Zurich, Switzerland
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Komulainen T, Bärlund V, Tanila H, Koivisto A, Jäkälä P. Incidence and Risk Factors of Transient Global Amnesia. Neuroepidemiology 2023; 57:246-252. [PMID: 37231955 DOI: 10.1159/000530713] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/27/2023] [Indexed: 05/27/2023] Open
Abstract
INTRODUCTION Transient global amnesia (TGA) is a spontaneously resolving, anterograde amnesia that lasts mostly <24 h and often occurs with retrograde amnesia. The etiology of TGA remains unclear, although in recent decades, many risk factors and preceding events have been identified. There are few up-to-date reports on the TGA incidence in Northern Europe. In this study, we report the incidence and risk factors associated with TGA in Finland. MATERIALS AND METHODS The study included all patients with suspected TGA that were referred to Kuopio University Hospital (KUH) in 2017. The hospital catchment area included 246,653 individuals. Risk factors and demographic data were collected from medical records. The TGA incidence rates were calculated as the number of patients with TGA divided by the number of individuals at risk in different age groups. RESULTS In 2017, 56 patients were treated for TGA at KUH. Of these, 46 had a first-ever TGA. The most common event preceding TGA was physical effort (n = 28, 50%), followed by emotional stress (n = 11, 19.6%) and water contact or a temperature change (n = 11, 19.6%). The most common comorbidities were hypercholesterolemia (n = 22, 39.3%), hypertensive disease (n = 21, 37.5%), hypothyroidism (n = 11, 19.6%), coronary artery disease (n = 8, 14.3%), and migraine (n = 7, 12.5%). TGA occurred most often in December (n = 9, 16.0%), March (n = 8, 14.3%), or October (n = 8, 14.3%), and least often in November and May (n = 2, 3.6% in both months). The crude incidence of a first TGA in Eastern Finland was 18.6/100,000 inhabitants, and when standardized to the European population in 2010, it was 14.3/100,000 inhabitants. Therefore, the TGA incidence was higher than previously reported in European countries. DISCUSSION The most common precipitating factors for TGA were physical effort, emotional stress, and water contact/temperature change. The incidence of TGA was high in the Eastern Finnish population.
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Affiliation(s)
- Tiina Komulainen
- Department of Neurology, University of Eastern Finland, Kuopio, Finland
- Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Venla Bärlund
- Department of Medicine, Päijät-Häme Central Hospital, Lahti, Finland
| | - Heikki Tanila
- A. I. Virtanen Institute, University of Eastern Finland, Kuopio, Finland
| | - Anne Koivisto
- Department of Neurology, University of Eastern Finland, Kuopio, Finland
- Department of Neurology, Kuopio University Hospital, Kuopio, Finland
- Helsinki University Hospital, Geriatrics, Internal Medicine and Rehabilitation, Helsinki, Finland
- Department of Neurosciences, University of Helsinki, Helsinki, Finland
| | - Pekka Jäkälä
- Department of Neurology, University of Eastern Finland, Kuopio, Finland
- Department of Neurology, Kuopio University Hospital, Kuopio, Finland
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Golenia A, Ferens A, Kolasa A, Ignatiuk A, Kostera-Pruszczyk A. Transient global amnesia - hippocampal lesions in magnetic resonance imaging. J Stroke Cerebrovasc Dis 2023; 32:106951. [PMID: 36565520 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/12/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Transient global amnesia is a benign syndrome characterized by a sudden onset loss of anterograde amnesia with full recovery. Magnetic resonance of the brain including diffusion-weighted imaging of patients with transient global amnesia revealed the presence of punctate hyperintense signal abnormalities in the hippocampus. OBJECTIVE Analysis of the presence of hippocampal lesions in brain magnetic resonance imaging in patients with transient global amnesia and the possible influence of additional factors on their appearance. METHODS In this retrospective, an observational study we assessed brain magnetic resonance imaging in 38 consecutive patients with transient global amnesia. The incidence of brain magnetic resonance imaging lesions was analyzed for the coexisting cardiovascular risk factors and precipitating events. RESULTS Hippocampal brain magnetic resonance imaging lesions were detected in 47% of patients with transient global amnesia. Of those, 65% had unilateral lesions, 82% were left-sided, and 28% were right-sided. Most lesions were located in the CA1 subfield. The incidence of hypertension in patients with transient global amnesia was higher than in the general population. Stress and exercise preceded the onset of transient global amnesia only in 13% and 16% of patients, respectively. There was no higher incidence of migraine in transient global amnesia patients (13%). CONCLUSIONS We found that nearly 50% of patients with transient global amnesia had hyperintense hippocampal brain magnetic resonance imaging lesions. In addition to hypertension, individuals with transient global amnesia had similar cardiovascular risk factors as the general population. We did not identify any precipitating events prior to the onset of transient global amnesia.
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Affiliation(s)
| | - Antoni Ferens
- Department of Neurology, Medical University of Warsaw, Poland.
| | - Anna Kolasa
- Department of Radiology, Medical University of Warsaw, Poland.
| | - Aleksandra Ignatiuk
- Department of Neurology, University Clinical Center, Medical University of Warsaw, Poland.
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Rogalewski A, Beyer A, Friedrich A, Zuhorn F, Klingebiel R, Woermann FG, Oertelt-Prigione S, Schäbitz WR. Transient Global Amnesia (TGA): Sex-Specific Differences in Blood Pressure and Cerebral Microangiopathy in Patients with TGA. J Clin Med 2022; 11:jcm11195803. [PMID: 36233669 PMCID: PMC9571788 DOI: 10.3390/jcm11195803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/09/2022] [Accepted: 09/27/2022] [Indexed: 11/16/2022] Open
Abstract
Transient global amnesia (TGA) is defined by an acute memory disturbance of unclear aetiology for a period of less than 24 h. Observed psychological, neuroanatomical and hormonal differences between the sexes in episodic memory suggest sex-specific differences in memory disorders such as TGA. The aim of this study was to determine sex-specific differences in cardiovascular risk profiles, recurrences and magnetic resonance imaging (MRI). In total, 372 hospitalised TGA patients between 01/2011 and 10/2021 were retrospectively analysed. Comparisons were made between female and male TGA patients and compared to 216 patients with acute stroke. In our sample, women were overrepresented (61.8%), especially compared to the general population in the 65−74 age category (χ2 = 10.6, p < 0.02). On admission, female TGA patients had significantly higher systolic blood pressure values and a higher degree of cerebral microangiopathy compared to male TGA patients, whereas acute stroke patients did not. No sex-specific differences were observed with respect to recurrences or hippocampal DWI lesions. Our data demonstrate sex-specific differences in TGA. The higher blood pressure on admission and different degree of cerebral microangiopathy in female TGA patients supports the theory of blood pressure dysregulation as a disease trigger. Distinct precipitating events in female and male patients could lead to differences in the severity and duration of blood pressure abnormalities, possibly explaining the higher incidence in female patients.
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Affiliation(s)
- Andreas Rogalewski
- Department of Neurology, Evangelisches Klinikum Bethel, University Hospital OWL, University Bielefeld, 33611 Bielefeld, Germany
- Correspondence: ; Tel.: +49-521-772-78301; Fax: +49-521-772-78302
| | - Anne Beyer
- Department of Neurology, Evangelisches Klinikum Bethel, University Hospital OWL, University Bielefeld, 33611 Bielefeld, Germany
| | - Anja Friedrich
- Department of Psychology, Bielefeld University, 33615 Bielefeld, Germany
| | - Frédéric Zuhorn
- Department of Neurology, Evangelisches Klinikum Bethel, University Hospital OWL, University Bielefeld, 33611 Bielefeld, Germany
| | - Randolf Klingebiel
- Department of Neuroradiology, Evangelisches Klinikum Bethel EvKB, University Hospital OWL, University Bielefeld, 33617 Bielefeld, Germany
| | - Friedrich G. Woermann
- Department of Epileptology (Krankenhaus Mara), University Hospital OWL, University Bielefeld, 33617 Bielefeld, Germany
| | | | - Wolf-Rüdiger Schäbitz
- Department of Neurology, Evangelisches Klinikum Bethel, University Hospital OWL, University Bielefeld, 33611 Bielefeld, Germany
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Forgetting the Unforgettable: Transient Global Amnesia Part II: A Clinical Road Map. J Clin Med 2022; 11:jcm11143940. [PMID: 35887703 PMCID: PMC9319625 DOI: 10.3390/jcm11143940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/03/2022] [Accepted: 07/05/2022] [Indexed: 12/14/2022] Open
Abstract
Transient global amnesia (TGA) is a clinical syndrome characterized by the sudden onset of a temporary memory disorder with profound anterograde amnesia and a variable impairment of the past memory. Usually, the attacks are preceded by a precipitating event, last up to 24 h and are not associated with other neurological deficits. Diagnosis can be challenging because the identification of TGA requires the exclusion of some acute amnestic syndromes that occur in emergency situations and share structural or functional alterations of memory circuits. Magnetic Resonance Imaging (MRI) studies performed 24–96 h after symptom onset can help to confirm the diagnosis by identifying lesions in the CA1 field of the hippocampal cornu ammonis, but their practical utility in changing the management of patients is a matter of discussion. In this review, we aim to provide a practical approach to early recognition of this condition in daily practice, highlighting both the lights and the shadows of the diagnostic criteria. For this purpose, we summarize current knowledge about the clinical presentation, diagnostic pathways, differential diagnosis, and the expected long-term outcome of TGA.
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Sparaco M, Pascarella R, Muccio CF, Zedde M. Forgetting the Unforgettable: Transient Global Amnesia Part I: Pathophysiology and Etiology. J Clin Med 2022; 11:3373. [PMID: 35743444 PMCID: PMC9225344 DOI: 10.3390/jcm11123373] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/04/2022] [Accepted: 06/09/2022] [Indexed: 02/04/2023] Open
Abstract
Transient global amnesia (TGA) is a clinical syndrome characterized by the sudden onset of a temporary memory disorder with a profound anterograde amnesia and a variable impairment of the past memory. Since the first description, dating back over 60 years, several cases have beenreported in the literature. Nevertheless, TGA remains one of the most mysterious diseases in clinical neurology. The debate regarding the etiology of this disease has focused mainly on three different mechanisms: vascular (due to venous flow changes or focal arterial ischemia), epileptic, and migraine related. However, to date there is no scientific proof of any of these mechanisms. Furthermore, the demonstration by diffusion-weighted MRI of lesions in the CA1 field of the hippocampus cornu ammonis led us to hypothesize that the selective vulnerability of CA1 neurons to metabolic stress could play a role in the pathophysiology of TGA. In this review, we summarize current knowledge on the anatomy, vascularization and function of the hippocampus. Furthermore, we discuss the emerging theories on the etiology and the pathophysiological cascade leading to an impairment of hippocampal function during the attacks.
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Affiliation(s)
- Marco Sparaco
- Neurology Unit, Stroke Unit, Department of Neurosciences, A.O. “San Pio”, P.O. “G. Rummo”, Via Dell’Angelo 1, 82100 Benevento, BN, Italy;
| | - Rosario Pascarella
- Neuroradiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, RE, Italy;
| | - Carmine Franco Muccio
- Neuroradiology Unit, Department of Neurosciences, A.O. “San Pio”, P.O. “G. Rummo”, Via Dell’Angelo 1, 82100 Benevento, BN, Italy;
| | - Marialuisa Zedde
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, RE, Italy
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Hernández MA, Arena JE, Alessandro L, Allegri RF, Calandri IL. Transient Global Amnesia Recurrence: Prevalence and Risk Factor Meta-analysis. Neurol Clin Pract 2022; 12:e35-e48. [DOI: 10.1212/cpj.0000000000001181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 03/24/2022] [Indexed: 11/15/2022]
Abstract
ABSTRACTBackground:Transient global amnesia (TGA) is an acute amnestic disorder with unclear pathophysiology. Although considered a benign phenomenon, the possibility of a recurrence is a major concern for the patient. Our objective is to identify the prevalence and risk factors of relapse, to help clinicians counsel patients about it.Methods:According to PRISMA guidance, we screened 1658 studies from MEDLINE, Lilacs and Embase databases, published from 1985 to April 2021, in English or Spanish. We included 36 observational case-control and cohort studies that included patients with TGA according to Caplan’s or Hodges and Warlow’s diagnostic criteria. We performed a meta-analysis with a random effect model for proportions and calculation of odds ratio for identified risk factors. Methodological quality was assessed according to the Newcastle-Ottawa Scale.Results:We identified 4514 TGA and 544 recurrence events (12.73%). Follow-up had no impact on its variance. We identified a statistically significant association between recurrence and sexual activity as a trigger, past or present personal history of migraine and depression (OR 1,481 95%CI [1,0341; 2,1222] p=0,04; OR=2,0795 IC95% [1,3892; 3,1128] p=0,003; and OR=4,487195%CI [1,890; 10,651] p=0,0288, respectively).Conclusions:The analysis showed that about 1 out of 8 subjects may have recurrence, with an increased risk in case of past or present history of migraine, depression or sexual intercourse prior to the event. Personal history of migraine and depression are associated with two and four times risk, respectively.
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Rogalewski A, Beyer A, Friedrich A, Plümer J, Zuhorn F, Klingebiel R, Woermann FG, Bien CG, Greeve I, Schäbitz WR. Transient Global Amnesia (TGA): Younger Age and Absence of Cerebral Microangiopathy Are Potentially Predisposing Factors for TGA Recurrence. Front Neurol 2021; 12:736563. [PMID: 34777205 PMCID: PMC8579867 DOI: 10.3389/fneur.2021.736563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/13/2021] [Indexed: 11/19/2022] Open
Abstract
Background: Transient global amnesia (TGA) is defined by an acute memory disturbance of unclear etiology for a period of less than 24 h. TGA occurs as a single event in most cases. Prevalence rates of recurrent TGA vary widely from 5.4 to 27.1%. This retrospective study aimed to determine predictors for TGA recurrence. Methods: Cardiovascular risk profile and magnetic resonance imaging (MRI) of 340 hospitalized TGA patients between 2011 and 2020 were retrospectively analyzed. The median follow-up period amounted to 4.5 ± 2.7 years. Comparisons were made between TGA patients with and without subsequent recurrence. Results: TGA patients with subsequent recurrence were significantly younger (recurrent vs. single episode, 63.6 ± 8.6 years vs. 67.3 ± 10.5 years, p = 0.032) and showed a lower degree of cerebral microangiopathy compared to TGA patients without recurrence. The mean latency to recurrence was 3.0 years ± 2.1 years after the first episode. In a subgroup analysis, patients with at least five years of follow-up (N = 160, median follow-up period 7.0 ± 1.4 years) had a recurrence rate of 11.3%. A 24.5% risk of subsequent TGA recurrence in the following five years was determined for TGA patients up to 70 years of age without microangiopathic changes on MRI (Fazekas' score 0). Conclusion: Younger TGA patients without significant microangiopathy do have an increased recurrence risk. In turn, pre-existing cerebrovascular pathology, in the form of chronic hypertension and cerebral microangiopathy, seems to counteract TGA recurrence.
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Affiliation(s)
- Andreas Rogalewski
- Department of Neurology, Evangelisches Klinikum Bethel, University Hospital OWL, University Bielefeld, Campus Bielefeld-Bethel, Bielefeld, Germany
| | - Anne Beyer
- Department of Neurology, Evangelisches Klinikum Bethel, University Hospital OWL, University Bielefeld, Campus Bielefeld-Bethel, Bielefeld, Germany
| | - Anja Friedrich
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Jorge Plümer
- Department of Neurology, Evangelisches Klinikum Bethel, University Hospital OWL, University Bielefeld, Campus Bielefeld-Bethel, Bielefeld, Germany
| | - Frédéric Zuhorn
- Department of Neurology, Evangelisches Klinikum Bethel, University Hospital OWL, University Bielefeld, Campus Bielefeld-Bethel, Bielefeld, Germany
| | - Randolf Klingebiel
- Department of Neuroradiology, Evangelisches Klinikum Bethel EvKB, University Hospital OWL, University Bielefeld, Campus Bielefeld-Bethel, Bielefeld, Germany
| | - Friedrich G Woermann
- Department of Epileptology (Krankenhaus Mara), Medical School, Bielefeld University, Bielefeld, Germany
| | - Christian G Bien
- Department of Epileptology (Krankenhaus Mara), Medical School, Bielefeld University, Bielefeld, Germany
| | - Isabell Greeve
- Department of Neurology, Evangelisches Klinikum Bethel, University Hospital OWL, University Bielefeld, Campus Bielefeld-Bethel, Bielefeld, Germany
| | - Wolf-Rüdiger Schäbitz
- Department of Neurology, Evangelisches Klinikum Bethel, University Hospital OWL, University Bielefeld, Campus Bielefeld-Bethel, Bielefeld, Germany
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Rogalewski A, Beyer A, Friedrich A, Plümer J, Zuhorn F, Greeve I, Klingebiel R, Woermann FG, Bien CG, Schäbitz WR. Transient Global Amnesia (TGA): Influence of Acute Hypertension in Patients Not Adapted to Chronic Hypertension. Front Neurol 2021; 12:666632. [PMID: 34305782 PMCID: PMC8296302 DOI: 10.3389/fneur.2021.666632] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/25/2021] [Indexed: 11/21/2022] Open
Abstract
Objective: Transient global amnesia (TGA) is defined by an acute memory disturbance of unclear etiology for a period of <24 h. Several studies showed differences in vascular risk factors between TGA compared to transient ischemic attack (TIA) or healthy controls with varying results. This retrospective and cross-sectional study compares the cardiovascular risk profile of TGA patients with that of acute stroke patients. Methods: Cardiovascular risk profile and MR imaging of 277 TGA patients was retrospectively analyzed and compared to 216 acute ischemic stroke patients (26% TIA). Results: TGA patients were significantly younger and predominantly female compared to stroke patients. A total of 90.6% of TGA patients underwent MRI, and 53% of those showed hippocampal diffusion-weighted imaging (DWI) lesions. Scores for cerebral microangiopathy were lower in TGA patients compared to stroke patients. After statistical correction for age, TGA patients had higher systolic and diastolic blood pressure, higher cholesterol levels, lower HbA1c, as well as blood glucose levels, and lower CHA2DS2-VASc scores. Stroke patients initially displayed higher CRP levels than TIA and TGA patients. TGA patients without DWI lesions were older and showed higher CHA2DS2-VASc scores compared to TGA patients with DWI lesions. Conclusion: This study revealed significant differences between TGA and stroke patients in regard to the cardiovascular risk profile. Our main findings show a strong association between acute hypertensive peaks and TGA in patients not adapted to chronic hypertension, indicating a vascular cause of the disease.
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Affiliation(s)
- Andreas Rogalewski
- Department of Neurology, Evangelisches Klinikum Bethel, University Hospital OWL of the University Bielefeld, Bielefeld, Germany
| | - Anne Beyer
- Department of Neurology, Evangelisches Klinikum Bethel, University Hospital OWL of the University Bielefeld, Bielefeld, Germany
| | - Anja Friedrich
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Jorge Plümer
- Department of Neurology, Evangelisches Klinikum Bethel, University Hospital OWL of the University Bielefeld, Bielefeld, Germany
| | - Frédéric Zuhorn
- Department of Neurology, Evangelisches Klinikum Bethel, University Hospital OWL of the University Bielefeld, Bielefeld, Germany
| | - Isabell Greeve
- Department of Neurology, Evangelisches Klinikum Bethel, University Hospital OWL of the University Bielefeld, Bielefeld, Germany
| | - Randolf Klingebiel
- Department of Neuroradiology, Evangelisches Klinikum Bethel, University Hospital OWL of the University Bielefeld, Bielefeld, Germany
| | - Friedrich G Woermann
- Department of Epileptology (Krankenhaus Mara), Bielefeld University, Medical School, Bielefeld, Germany
| | - Christian G Bien
- Department of Epileptology (Krankenhaus Mara), Bielefeld University, Medical School, Bielefeld, Germany
| | - Wolf-Rüdiger Schäbitz
- Department of Neurology, Evangelisches Klinikum Bethel, University Hospital OWL of the University Bielefeld, Bielefeld, Germany
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Morris KA, Rabinstein AA, Young NP. Factors Associated With Risk of Recurrent Transient Global Amnesia. JAMA Neurol 2021; 77:1551-1558. [PMID: 32865551 DOI: 10.1001/jamaneurol.2020.2943] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Transient global amnesia (TGA) is usually considered a benign event with a low recurrence rate. However, recurrence rates vary considerably among studies and there are no known risk factors for TGA. Objective To examine risk factors for the recurrence of TGA. Design, Setting, and Participants This retrospective cohort study involved medical record review of patients with isolated or recurrent TGA presenting to the Mayo Clinic in Rochester, Minnesota, between August 1, 1992, and February 28, 2018. A total of 1491 cases were reviewed and 1044 met diagnostic inclusion criteria for TGA, with the remainder excluded owing to indeterminate or alternate diagnoses or limited information available in the medical record. Exposures Single vs recurrent episodes of TGA. Main Outcomes and Measures Demographics, precipitating factors, migraine history, imaging and electrodiagnostic findings, and family history of TGA were collected. The main outcome measure was TGA recurrence. Results Of 1044 included patients, 575 (55.1%) were male, and the mean (SD) age at inclusion was 75.0 (11.5) years. A total of 901 patients (86.3%) had a single episode of TGA and 143 (13.7%) had recurrent episodes of TGA. The 2 groups were similar in age at inclusion, sex, identifiable triggers, and duration of anterograde amnesia. The number of recurrences ranged from 1 to 9, with 137 individuals (95.8%) having 3 or fewer recurrences. The mean (SD) age at first episode of TGA was 65.2 (10.0) years for individuals with a single episode vs 58.8 (10.3) years for those with recurrent episodes (P < .001). There was a personal history of migraine in 180 individuals (20.0%) with a single episode of TGA and 52 individuals (36.4%) with recurrent episodes of TGA (P < .001), and a family history of migraine in 167 individuals (18.5%) with a single episode of TGA and 44 individuals (30.8%) with recurrent episodes of TGA (P = .001). There were no electroencephalographic findings associated with increased risk of TGA recurrence. Acute and subacute temporal lobe abnormalities on results of magnetic resonance imaging were seen rarely and did not require intervention. A family history of TGA was identified in 12 individuals (1.3%) with a single episode of TGA and 4 individuals (2.8%) with recurrent episodes of TGA. Conclusions and Relevance This study suggests that, in this large cohort of patients with TGA, recurrent TGA was associated with earlier age at the time of first TGA episode and higher prevalence of both personal and family history of migraine compared with isolated cases. These results can be used to counsel patients about risks of recurrence and may have implications for the understanding of TGA pathophysiology.
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Affiliation(s)
- Ken A Morris
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | | | - Nathan P Young
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
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Conventional cardiovascular risk factors in Transient Global Amnesia: Systematic review and proposition of a novel hypothesis. Front Neuroendocrinol 2021; 61:100909. [PMID: 33539928 DOI: 10.1016/j.yfrne.2021.100909] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/07/2021] [Accepted: 01/27/2021] [Indexed: 12/15/2022]
Abstract
Transient Global Amnesia (TGA) is an enigmatic amnestic syndrome. We conducted a systematic review to investigate the relationship between the conventional cardiovascular risk factors and TGA. MEDLINE, CENTRAL, EMBASE and PsycINFO were comprehensively searched and 23 controlled observational studies were retrieved. The prevalence of hypertension, diabetes mellitus, dyslipidemia and smoking was lower among patients with TGA compared to Transient Ischemic Attack. Regarding the comparison of TGA with healthy individuals, there was strong evidence suggesting a protective effect of diabetes mellitus on TGA and weaker evidence for a protective effect of smoking. Hypertension was associated with TGA only in more severe stages, while dyslipidemia was not related. In view of these findings, a novel pathophysiological hypothesis is proposed, in which the functional interactions of Angiotensin-II type-1 and N-methyl-D-aspartate receptors are of pivotal importance. The whole body of clinical evidence (nature of precipitating events, associations with migraine, gender-based association patterns) was integrated.
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12
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Liampas I, Raptopoulou M, Mpourlios S, Siokas V, Tsouris Z, Aloizou AM, Dastamani M, Brotis A, Bogdanos D, Xiromerisiou G, Dardiotis E. Factors associated with recurrent transient global amnesia: systematic review and pathophysiological insights. Rev Neurosci 2021; 32:751-765. [PMID: 33675214 DOI: 10.1515/revneuro-2021-0009] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 02/15/2021] [Indexed: 12/20/2022]
Abstract
The examination of the risk factors that affect the recurrence of transient global amnesia (TGA) may shed light on the pathophysiological substrate of the disease. A systematic review was performed to identify the factors associated with the recurrence of TGA. MEDLINE, EMBASE, CENTRAL and PsycINFO were meticulously searched. Observational controlled studies involving patients with single (s-TGA) and recurrent TGA (r-TGA) according to Hodges and Warlow's criteria were retrieved. Differences in the demographic characteristics, personal and family medical history, previous exposure to precipitating events and laboratory findings were examined. Retrieved evidence was assessed in the context of the individual article validity, based on the numerical power and methodological quality of each study. Nine cohort studies with retrospective, prospective or mixed design were retrieved. In total, 1989 patients with TGA were included, 269 of whom suffered from r-TGA (13.5%). R-TGA presented an earlier age of onset. Evidence was suggestive of a relationship between recurrence and a family or personal history of migraine, as well as a personal history of depression. There was weaker evidence that associated recurrence with a positive family history of dementia, a personal history of head injury and hippocampal lesions in diffusion-weighted MRI. On the other hand, no connection was found between recurrence and electroencephalographic abnormalities, impaired jugular venous drainage, cardiovascular risk factors, atrial fibrillation, previous cerebrovascular events, exposure to precipitating events, a positive family history of TGA and hypothyroidism. Important pathophysiological insights that arised from these findings were discussed.
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Affiliation(s)
- Ioannis Liampas
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Mezourlo Hill, 41100Larissa, Greece
| | - Maria Raptopoulou
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Mezourlo Hill, 41100Larissa, Greece.,First Department of Internal Medicine, General Hospital of Trikala, Karditsis 56, 42100Trikala, Greece
| | - Stefanos Mpourlios
- School of Medicine, University of Thessaly, Mezourlo Hill, 41100Larissa, Greece
| | - Vasileios Siokas
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Mezourlo Hill, 41100Larissa, Greece
| | - Zisis Tsouris
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Mezourlo Hill, 41100Larissa, Greece
| | - Athina-Maria Aloizou
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Mezourlo Hill, 41100Larissa, Greece
| | - Metaxia Dastamani
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Mezourlo Hill, 41100Larissa, Greece
| | - Alexandros Brotis
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Mezourlo Hill, 41100Larissa, Greece
| | - Dimitrios Bogdanos
- Department of Rheumatology and clinical Immunology, University Hospital of Larissa, School of Medicine, University of Thessaly, Mezourlo Hill, 41100Larissa, Greece
| | - Georgia Xiromerisiou
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Mezourlo Hill, 41100Larissa, Greece
| | - Efthimios Dardiotis
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Mezourlo Hill, 41100Larissa, Greece
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Coelho P, Schön M, Alves PN, Fonseca AC, Pinho E Melo T. An image is not always worth a thousand words: an image mimic of transient global amnesia. Neurol Sci 2021; 42:2515-2517. [PMID: 33462633 DOI: 10.1007/s10072-021-05050-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 01/08/2021] [Indexed: 10/22/2022]
Abstract
Transient global amnesia (TGA) is a neurological syndrome with rather distinctive brain MRI features, namely hyperintense lesion in hippocampus on diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) sequences. Post-traumatic amnesia is another amnestic syndrome which can also show hyperintense lesions in brain MRI due to cytotoxic oedema caused by traumatic brain injury. We present a case of a patient with post-traumatic amnesia with a brain MRI image mimic of TGA.
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Affiliation(s)
- Pedro Coelho
- Department of Neurosciences and Mental Health, Neurology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Avenida Professor Egas Moniz, 1649-035, Lisbon, Portugal.
| | - Miguel Schön
- Department of Neurosciences and Mental Health, Neurology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Avenida Professor Egas Moniz, 1649-035, Lisbon, Portugal
| | - Pedro Nascimento Alves
- Department of Neurosciences and Mental Health, Neurology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Avenida Professor Egas Moniz, 1649-035, Lisbon, Portugal.,Language Research Laboratory, Faculty of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - Ana Catarina Fonseca
- Department of Neurosciences and Mental Health, Neurology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Avenida Professor Egas Moniz, 1649-035, Lisbon, Portugal.,Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Teresa Pinho E Melo
- Department of Neurosciences and Mental Health, Neurology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Avenida Professor Egas Moniz, 1649-035, Lisbon, Portugal.,Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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14
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Migraine in transient global amnesia: a meta-analysis of observational studies. J Neurol 2021; 269:184-196. [PMID: 33388926 DOI: 10.1007/s00415-020-10363-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND PURPOSE: Although many studies have investigated the relationship between transient global amnesia (TGA) and migraine, to date, no meta-analysis has confirmed the existence and size of their association. METHODOLOGY Literature search involved MEDLINE, EMBASE, CENTRAL and PsycINFO. Observational controlled studies including TGA patients (Caplan, Hodges and Warlow) were retrieved. Quality evaluation was based on the Newcastle-Ottawa scale. The prevalence of migraine was compared in TGA patients vs. healthy controls (HC), as well as in TGA against TIA individuals. Data from case-control, cross-sectional and cohort studies were pooled separately. RESULTS Literature search yielded 1178 articles, 12 of which were included in the present meta-analysis. Results from case-control (ten), cohort (one) and cross-sectional (one) studies were compatible with an association between TGA and migraine. The nationwide inpatient cross-sectional study was of lesser value due to its inpatient orientation. The high-quality, population-based, retrospective cohort (158,301 participants per group) determined a higher relative-risk (RR) of TGA for migraine vs. non-migraine individuals [RR = 2.48, 95%confidence-interval (95% CI) = (1.32, 4.87)]. Sensitivity testing based on stricter diagnostic criteria strengthened the estimated association [RR = 3.84, 95% CI = (1.57, 9.38)]. Additionally, pooled data from eight case-control studies (700 TGA, 746 HC) yielded similar results [Odds-Ratio, OR = 2.51, 95% CI = (1.85, 3.41)], with the association mainly driven by the three high-quality studies, rather than the five articles of moderate quality. Finally, pooled findings from four case-control studies of moderate-quality revealed a higher prevalence of migraine among TGA compared to TIA patients [OR = 1.82, 95% CI = (1.22, 2.73)]. CONCLUSIONS A significant association between TGA and migraine was established. The underlying connecting mechanism remains undetermined, yet.
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15
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Tynas R, Panegyres PK. Factors determining recurrence in transient global amnesia. BMC Neurol 2020; 20:83. [PMID: 32143587 PMCID: PMC7060647 DOI: 10.1186/s12883-020-01658-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 02/25/2020] [Indexed: 11/15/2022] Open
Abstract
Background Aetiology of transient global amnesia (TGA) remains uncertain, though many have been proposed, including ischaemic, migrainous or epileptic pathologies. Methods We attempted to determine risk factors for TGA, as well as prognostic factors that may cause recurrence. We evaluated clinical history, family history and magnetic resonance diffusion-weighted imaging (DWI) studies of 93 prospective patients with TGA. Patients were followed from 2004 to 2016. Fifteen of 93 (16%) patients experienced a recurrence of TGA. Results Among precipitating events, physical activities inducing Valsalva-like manoeuvres were most common, followed by emotional stress. Eighty-four patients had possible comorbidities or risk factors for TGA, though no single risk factor was ubiquitous. Risk factors associated with recurrence were head injury (isolated vs. recurrent, 16.7% vs. 53.5%, p < 0.01), depression (isolated vs. recurrent, 15.4% vs 46.7%, p = 0.01) and family history of dementia (isolated vs. recurrent, 20.5% vs. 46.7%, p = 0.03). Of 15 patients with confirmed recurrent TGA, two developed dementia and four subjective memory impairment. DWI lesions were observed in 24 patients and were located anywhere within the hippocampus. Conclusions DWI lesions were not significantly associated with outcomes (recurrence, subjective memory impairment, dementia). We have found that depression, previous head injury and family history of dementia may predict TGA recurrence.
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Affiliation(s)
- Rebecca Tynas
- The University of Western Australia, Nedlands, Australia
| | - Peter K Panegyres
- The University of Western Australia, Nedlands, Australia. .,Neurodegenerative Disorders Research Pty Ltd, 4 Lawrence Avenue, West Perth, Western Australia, 6005.
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16
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Alessandro L, Calandri IL, Suarez MF, Heredia ML, Chaves H, Allegri RF, Farez MF. Transient global amnesia: clinical features and prognostic factors suggesting recurrence. ARQUIVOS DE NEURO-PSIQUIATRIA 2019; 77:3-9. [PMID: 30758436 DOI: 10.1590/0004-282x20180157] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 10/17/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The risk of recurrence of new amnesia events in patients having previously experienced transient global amnesia (TGA) ranges between 2.9-23.8%. Our objective was to search for recurrence predictors in TGA patients. METHODS Retrospective analysis to identify recurrence predictors in a cohort of 203 TGA patients from a single center in Buenos Aires, Argentina, diagnosed between January 2011 and March 2017 Clinical features and complementary studies (laboratory results, jugular vein Doppler ultrasound and brain MRI) were analyzed. Comparison between patients with recurrent versus single episode TGA was performed, applying a multivariate logistic regression model. RESULTS Mean age at presentation was 65 years (20-84); 52% were female. Median time elapsed between symptom onset and ER visit was two hours, with the average episode duration lasting four hours. Mean follow-up was 22 months. Sixty-six percent of patients referred to an identifiable trigger. Jugular reflux was present in 66% of patients; and 22% showed images with hippocampus restriction on diffusion-weighted MRI. Eight percent of patients had TGA recurrence. Patients with recurrent TGA had a more frequent history of migraine than patients without recurrence (37.5% vs. 14%; p = 0.03). None of the other clinical characteristics and complementary studies were predictors of increased risk of recurrence. CONCLUSIONS Patients with migraine may have a higher risk of recurrent TGA. None of the other clinical characteristics evaluated allowed us to predict an increased risk of recurrence. Although the complementary studies allowed us to guide the diagnosis, they did not appear to have a significant impact on the prediction of recurrence risk.
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Affiliation(s)
- Lucas Alessandro
- Raúl Carrea Institute for Neurological Research (FLENI), Department of Neurology, Buenos Aires, Argentina
| | - Ismael L Calandri
- Raúl Carrea Institute for Neurological Research (FLENI), Department of Neurology, Buenos Aires, Argentina
| | | | - María L Heredia
- Raúl Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina
| | - Hernán Chaves
- Department of Diagnostic Imaging, Raúl Carrea Institute for Neurological Research (FLENI), Department of Neurology, Buenos Aires, Argentina
| | - Ricardo F Allegri
- Raúl Carrea Institute for Neurological Research (FLENI), Department of Neurology, Buenos Aires, Argentina
| | - Mauricio F Farez
- Center for Research on Neuroimmunological Diseases (CIEN), Raúl Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina
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17
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Spiegel DR, Smith J, Wade RR, Cherukuru N, Ursani A, Dobruskina Y, Crist T, Busch RF, Dhanani RM, Dreyer N. Transient global amnesia: current perspectives. Neuropsychiatr Dis Treat 2017; 13:2691-2703. [PMID: 29123402 PMCID: PMC5661450 DOI: 10.2147/ndt.s130710] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Transient global amnesia (TGA) is a clinical syndrome characterized by the sudden onset of an extraordinarily large reduction of anterograde and a somewhat milder reduction of retrograde episodic long-term memory. Additionally, executive functions are described as diminished. Although it is suggested that various factors, such as migraine, focal ischemia, venous flow abnormalities, and epileptic phenomena, are involved in the pathophysiology and differential diagnosis of TGA, the factors triggering the emergence of these lesions are still elusive. Recent data suggest that the vulnerability of CA1 neurons to metabolic stress plays a pivotal part in the pathophysiological cascade, leading to an impairment of hippocampal function during TGA. In this review, we discuss clinical aspects, new imaging findings, and recent clinical-epidemiological data with regard to the phenotype, functional anatomy, and putative cellular mechanisms of TGA.
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Affiliation(s)
- David R Spiegel
- Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Justin Smith
- Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Ryan R Wade
- Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Nithya Cherukuru
- Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Aneel Ursani
- Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Yuliya Dobruskina
- Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Taylor Crist
- Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Robert F Busch
- Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Rahim M Dhanani
- Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Nicholas Dreyer
- Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, Norfolk, VA, USA
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18
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Himeno T, Kuriyama M, Takemaru M, Kanaya Y, Shiga Y, Takeshima S, Takamatsu K, Shimoe Y, Fukushima T, Matsubara E. Vascular Risk Factors and Internal Jugular Venous Flow in Transient Global Amnesia: A Study of 165 Japanese Patients. J Stroke Cerebrovasc Dis 2017; 26:2272-2278. [PMID: 28669658 DOI: 10.1016/j.jstrokecerebrovasdis.2017.05.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 05/03/2017] [Accepted: 05/07/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The etiology of transient global amnesia (TGA) remains unclear. We studied the pathophysiology of TGA in 165 Japanese patients. SUBJECTS AND METHODS TGA was diagnosed in hospitalized patients from 2004 to 2015. We analyzed clinical characteristics, magnetic resonance imaging findings, and maximum intima-media thickness of the common carotid artery, and the reflux of internal jugular venous (IJV) flow by ultrasonography, and statistically compared patients with TGA with age-matched and sex-matched patients who have had a transient ischemic attack (TIA), small-vessel occlusion (SVO), and normal controls (each group, N = 165). RESULTS Patients with TGA showed lower prevalence of vascular risk factors than patients with TIA and SVO did. Eleven patients (6.7%) had 2 episodes of TAG, but specific clinical variables could not be recognized in these patients. The maximum intima-media thickness was significantly thinner in TGA (1.1 ± .7 mm) than in SVO (1.6 ± .9 mm; P = .001). The percentages of cases whose IJV flow reflux was increased by Valsalva maneuver showed no difference (P = .573) between TGA (26.0 %) and SVO (29.4%). MR diffusion-weighted imaging yielded small hyperintense signals in the hippocampus in 64 of 90 (71.1%) patients between 24 and 72 hours. Potential precipitating specific factors or events before the attacks could be recognized in 40 cases (24.2%) of 165 patients. CONCLUSION Arterial ischemia and IJV flow reflux might not contribute to TGA pathophysiology. The vulnerability of the hippocampus to physical or emotional stress might be suspected as an underlying mechanism in some patients with TGA.
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Affiliation(s)
- Takahiro Himeno
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, Hiroshima, Japan; Department of Neurology, Faculty of Medicine, Oita University, Oita, Japan
| | - Masaru Kuriyama
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, Hiroshima, Japan.
| | - Makoto Takemaru
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, Hiroshima, Japan; Department of Neurology, Faculty of Medicine, Oita University, Oita, Japan
| | - Yuhei Kanaya
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, Hiroshima, Japan
| | - Yuji Shiga
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, Hiroshima, Japan
| | - Shinichi Takeshima
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, Hiroshima, Japan
| | - Kazuhiro Takamatsu
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, Hiroshima, Japan
| | - Yutaka Shimoe
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, Hiroshima, Japan
| | - Tomoko Fukushima
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, Hiroshima, Japan
| | - Etsuro Matsubara
- Department of Neurology, Faculty of Medicine, Oita University, Oita, Japan
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Michel P, Beaud V, Eskandari A, Maeder P, Demonet JF, Eskioglou E. Ischemic Amnesia: Causes and Outcome. Stroke 2017; 48:2270-2273. [PMID: 28584000 DOI: 10.1161/strokeaha.117.017420] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 03/30/2017] [Accepted: 04/21/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE We aimed to describe the frequency and characteristics of acute ischemic stroke and transient ischemic attacks presenting predominantly with amnesia (ischemic amnesia) and to identify clinical clues for differentiating them from transient global amnesia (TGA). METHODS We retrospectively analyzed and described all patients presenting with diffusion-weighted imaging magnetic resonance imaging-confirmed acute ischemic stroke/transient ischemic attacks with antero- and retrograde amnesia as the main symptom over a 13.5-year period. We also compared their clinical features and stroke mechanisms with 3804 acute ischemic stroke from our ischemic stroke registry. RESULTS Thirteen ischemic amnesia patients were identified, representing 0.2% of all patients with acute ischemic stroke/transient ischemic attack. In 69% of ischemic amnesia cases, amnesia was transient with a median duration of 5 hours. Ischemia was not considered in 39% of cases. Fifty-four percent of cases were clinically difficult to distinguish from TGA, including 15% who were indistinguishable from TGA. 1.2% of all presumed TGA patients at our center were later found to have ischemic amnesia. Amnesic strokes were more often cardioembolic, multiterritorial, and typically involved the posterior circulation and limbic system. Clinical clues were minor focal neurological signs, higher age, more risk factors, and stroke favoring circumstances. Although all patients were independent at 3 months, 31% had persistent memory problems. CONCLUSIONS Amnesia as the main symptom of acute ischemic cerebral events is rare, mostly transient, and easily mistaken for TGA. Although clinical clues are often present, the threshold for performing diffusion-weighted imaging in acute amnesia should be low.
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Affiliation(s)
- Patrik Michel
- From the Stroke Center, Neurology Service (P. Michel, A.E., E.E.), Neuropsychology and Neurorehabilitation Service (V.B.), Department of Diagnostic and Interventional Radiology (P. Maeder), and Leenaards Memory Centre (J.-F.D.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland.
| | - Valérie Beaud
- From the Stroke Center, Neurology Service (P. Michel, A.E., E.E.), Neuropsychology and Neurorehabilitation Service (V.B.), Department of Diagnostic and Interventional Radiology (P. Maeder), and Leenaards Memory Centre (J.-F.D.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland
| | - Ashraf Eskandari
- From the Stroke Center, Neurology Service (P. Michel, A.E., E.E.), Neuropsychology and Neurorehabilitation Service (V.B.), Department of Diagnostic and Interventional Radiology (P. Maeder), and Leenaards Memory Centre (J.-F.D.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland
| | - Philippe Maeder
- From the Stroke Center, Neurology Service (P. Michel, A.E., E.E.), Neuropsychology and Neurorehabilitation Service (V.B.), Department of Diagnostic and Interventional Radiology (P. Maeder), and Leenaards Memory Centre (J.-F.D.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland
| | - Jean-François Demonet
- From the Stroke Center, Neurology Service (P. Michel, A.E., E.E.), Neuropsychology and Neurorehabilitation Service (V.B.), Department of Diagnostic and Interventional Radiology (P. Maeder), and Leenaards Memory Centre (J.-F.D.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland
| | - Elissavet Eskioglou
- From the Stroke Center, Neurology Service (P. Michel, A.E., E.E.), Neuropsychology and Neurorehabilitation Service (V.B.), Department of Diagnostic and Interventional Radiology (P. Maeder), and Leenaards Memory Centre (J.-F.D.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland
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20
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Arena JE, Brown RD, Mandrekar J, Rabinstein AA. Long-Term Outcome in Patients With Transient Global Amnesia: A Population-Based Study. Mayo Clin Proc 2017; 92:399-405. [PMID: 28185658 PMCID: PMC5682935 DOI: 10.1016/j.mayocp.2016.11.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 10/15/2016] [Accepted: 11/28/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To study the long-term risk of cerebrovascular events, seizures, and cognitive impairment in patients with transient global amnesia (TGA). PATIENTS AND METHODS Data for all patients diagnosed with possible TGA in Olmsted County, Minnesota, between January 1, 1985, through December 31, 2010, were retrieved from the Rochester Epidemiology Project database. Transient global amnesia was defined clinically. End points were cerebrovascular event (stroke or transient ischemic attack), seizure, or cognitive impairment (mild cognitive impairment or dementia) during follow-up. End points were studied using Kaplan-Meier survival plots and log-rank test. RESULTS A total of 221 patients with TGA were identified and 221 age- and sex-matched controls were included in the analysis. The mean duration of follow-up was 12 years in both groups (range, 0.07-29.93). Prevalence of vascular risk factors and history of seizures were similar between both groups. Previous migraine was more common in the TGA group (42 patients [19.1%] vs 12 patients [5.4%]; P<.001). There was no statistically significant difference between survival curves for the TGA group and the control group using time to any type of cerebrovascular event (log-rank P=.30), time to seizures event (log-rank P=.55), and time to cognitive impair event (log-rank P=.88) as end points. The TGA recurrence occurred in 5.4% of patients after a median interval of 4.21 years (interquartile range, 2.82-8.44). Modified Rankin scale and death rates at last follow-up were also similar between both groups. CONCLUSION Our findings indicate that having an episode of TGA does not increase the risk of subsequent cerebrovascular events, seizures, or cognitive impairment.
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Affiliation(s)
| | | | - Jay Mandrekar
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
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21
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Jang JW, Park YH, Park SY, Wang MJ, Lim JS, Kim SH, Chun IK, Yang Y, Kim S. Longitudinal Cerebral Perfusion Change in Transient Global Amnesia Related to Left Posterior Medial Network Disruption. PLoS One 2015; 10:e0145658. [PMID: 26690067 PMCID: PMC4687008 DOI: 10.1371/journal.pone.0145658] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 12/07/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The pathophysiology of transient global amnesia (TGA) is not fully understood. Previous studies using single photon emission computed tomography (SPECT) have reported inconclusive results regarding cerebral perfusion. This study was conducted to identify the patterns of regional cerebral blood flow (rCBF) in TGA patients via longitudinal SPECT analysis. An association between the observed SPECT patterns and a pathophysiological mechanism was considered. METHODS Based on the TGA registry database of Seoul National University Bundang Hospital, 22 TGA patients were retrospectively identified. The subjects underwent initial Tc-99m-ethyl cysteinate dimer (ECD) SPECT within 4 days of an amnestic event and underwent follow-up scans approximately 6 months later. The difference in ECD uptake between the two scans was measured via voxel-based whole brain analysis, and the quantified ECD uptake was tested using a paired t-test. RESULTS The TGA patients had significantly decreased cerebral perfusion at the left precuneus (P<0.001, uncorrected) and at the left superior parietal and inferior temporal gyrus according to the voxel-based whole brain analysis (P<0.005, uncorrected). A difference in the quantified ECD uptake between the 2 scans was also found at the left precuneus among the 62 cortical volumes of interest (P = 0.018, Cohen's d = -0.25). CONCLUSION We identified left hemispheric lateralized hypoperfusion that may be related to posterior medial network disruption. These findings may be a contributing factor to the pathophysiology of TGA.
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Affiliation(s)
- Jae-Won Jang
- Department of Neurology, Kangwon National University Hospital, Chuncheon, Republic of Korea
| | - Young Ho Park
- Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
| | - So Young Park
- Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
| | - Min Jeong Wang
- Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Sung Lim
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
- Department of Neurology, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Sung-Hun Kim
- Department of Neurology, Kangwon National University Hospital, Chuncheon, Republic of Korea
| | - In KooK Chun
- Department of Nuclear Medicine, Kangwon National University Hospital, Chuncheon, Republic of Korea
| | - Youngsoon Yang
- Department of Neurology, Seoul Veterans Hospital, Seoul, Korea
| | - SangYun Kim
- Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
- * E-mail:
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Quinette P, Constans JM, Hainselin M, Desgranges B, Eustache F, Viader F. Hippocampal modifications in transient global amnesia. Rev Neurol (Paris) 2015; 171:282-8. [PMID: 25769554 DOI: 10.1016/j.neurol.2015.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 01/28/2015] [Indexed: 10/23/2022]
Abstract
Transient global amnesia (TGA) is an acute and transient syndrome with a remarkably stereotypical set of signs and symptoms. It is characterized by the abrupt onset (no forewarning) of massive episodic memory impairment, both anterograde and retrograde. Ever since it was first described, TGA has fascinated neurologists and other memory experts, and in recent years, there has been a surge of neuroimaging studies seeking to pin down the brain dysfunction responsible for it. Several pathophysiological hypotheses have been put forward, including the short-lived suggestion of an epileptic mechanism. All the available data indicate that the brain modifications are reversible, and that the mechanism behind TGA is of a functional nature. However, while diffusion-weighted imaging studies have clearly identified the hippocampus and, more specifically, the CA1 area, as the locus of brain modifications associated with TGA, researchers have yet to determine whether the origin of the mechanism is vascular or neurochemical. Spectroscopy may provide a means of settling this issue once and for all.
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Affiliation(s)
- P Quinette
- U1077, Inserm, 5, avenue de la Côte-de-Nacre, CS 30001, 14033 Caen Cedex 9, France; UMR-S1077, University of Caen - Basse-Normandie, esplanade de la Paix, 14032 Caen Cedex 5, France; UMR-S1077, École Pratique des Hautes Études, 5, avenue de la Côte-de-Nacre, 14032 Caen Cedex 5, France; U1077, Caen University Hospital, 5, avenue de la Côte-de-Nacre, 14033 Caen Cedex 9, France
| | - J M Constans
- Radiology and Medical Imaging Department, Amiens University Hospital, place Victor-Pauchet, 80054 Amiens Cedex 1, France
| | - M Hainselin
- U1077, Inserm, 5, avenue de la Côte-de-Nacre, CS 30001, 14033 Caen Cedex 9, France; UMR-S1077, University of Caen - Basse-Normandie, esplanade de la Paix, 14032 Caen Cedex 5, France; UMR-S1077, École Pratique des Hautes Études, 5, avenue de la Côte-de-Nacre, 14032 Caen Cedex 5, France; U1077, Caen University Hospital, 5, avenue de la Côte-de-Nacre, 14033 Caen Cedex 9, France; CRPCPO, EA 7273, University of Picardie Jules Verne, chemin du Thil, 80000 Amiens, France
| | - B Desgranges
- U1077, Inserm, 5, avenue de la Côte-de-Nacre, CS 30001, 14033 Caen Cedex 9, France; UMR-S1077, University of Caen - Basse-Normandie, esplanade de la Paix, 14032 Caen Cedex 5, France; UMR-S1077, École Pratique des Hautes Études, 5, avenue de la Côte-de-Nacre, 14032 Caen Cedex 5, France; U1077, Caen University Hospital, 5, avenue de la Côte-de-Nacre, 14033 Caen Cedex 9, France
| | - F Eustache
- U1077, Inserm, 5, avenue de la Côte-de-Nacre, CS 30001, 14033 Caen Cedex 9, France; UMR-S1077, University of Caen - Basse-Normandie, esplanade de la Paix, 14032 Caen Cedex 5, France; UMR-S1077, École Pratique des Hautes Études, 5, avenue de la Côte-de-Nacre, 14032 Caen Cedex 5, France; U1077, Caen University Hospital, 5, avenue de la Côte-de-Nacre, 14033 Caen Cedex 9, France.
| | - F Viader
- U1077, Inserm, 5, avenue de la Côte-de-Nacre, CS 30001, 14033 Caen Cedex 9, France; UMR-S1077, University of Caen - Basse-Normandie, esplanade de la Paix, 14032 Caen Cedex 5, France; UMR-S1077, École Pratique des Hautes Études, 5, avenue de la Côte-de-Nacre, 14032 Caen Cedex 5, France; U1077, Caen University Hospital, 5, avenue de la Côte-de-Nacre, 14033 Caen Cedex 9, France; Neurology Department, Caen University Hospital, avenue de la Côte-de-Nacre, 14033 Caen Cedex 9, France
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Arena JE, Rabinstein AA. Transient global amnesia. Mayo Clin Proc 2015; 90:264-72. [PMID: 25659242 DOI: 10.1016/j.mayocp.2014.12.001] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 11/24/2014] [Accepted: 12/01/2014] [Indexed: 11/20/2022]
Abstract
Transient global amnesia (TGA) is a clinical syndrome characterized by the sudden onset of anterograde amnesia (the inability to encode new memories), accompanied by repetitive questioning, sometimes with a retrograde component, lasting up to 24 hours, without compromise of other neurologic functions. Herein, we review current knowledge on the epidemiology, pathophysiology, clinical diagnosis, and prognosis of TGA. For this review, we conducted a literature search of PubMed, with no date limitations, using the following search terms (or combinations of them): transient global amnesia, etiology, pathophysiology, venous hypertension, migraine, magnetic resonance imaging, computed tomography, electroencephalography, prognosis, and outcome. We also reviewed the bibliography cited in the retrieved articles. Transient global amnesia is a clinical diagnosis, and recognition of its characteristic features can avoid unnecessary testing. Several pathophysiologic mechanisms have been proposed (venous insufficiency, arterial ischemia, and migrainous or epileptic phenomena), but none of them has been proved to consistently explain cases of TGA. Brain imaging may be considered and electroencephalography is recommended when episodes are brief and recurrent, but otherwise no investigations are necessary in most cases. Data on long-term prognosis are limited, but available information suggests that the relapse rate is low, the risk of stroke and seizures is not considerably increased, and cognitive outcome is generally good.
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Brigo F, Lochner P, Tezzon F, Nardone R. Incidence of transient global amnesia in Merano, province of Bolzano, Italy. Acta Neurol Belg 2014; 114:293-6. [PMID: 24515914 DOI: 10.1007/s13760-014-0281-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 01/22/2014] [Indexed: 11/26/2022]
Abstract
Few community-based studies determined the incidence of transient global amnesia (TGA), with annual incidence rates between 2.9 and 10.4/100,000. Data on sex distribution of TGA are discrepant. Aim of this study was to determine the incidence of TGA in Merano, province of Bolzano, Northern Italy. Cases were identified from hospital discharge diagnoses of all the Departments of the general hospital of Merano and neighboring towns. Patients fulfilling internationally accepted diagnostic criteria for TGA and residing in Merano were included. Crude, age- and sex-specific incidence rates were computed. The overall annual crude incidence rate of TGA was 9.6/100,000 inhabitants (9.5 % confidence interval 6.7-13.3), 10.1/100,000 for men and 8.9/100,000 for women (p < 0.001). After adjustment by the direct method to the European population, the annual incidence rate was 6.4/100,000. The incidence rate of TGA in Merano, Italy, does not differ from that reported in Turku, Finland and Belluno, Italy. This study confirms that this benign syndrome is relatively common and occurs mainly in elderly patients. However, the higher male predominance in TGA incidence rates contrasts with previous epidemiological studies. Further, prospective incidence studies should therefore be conducted to further clarify sex predominance in TGA.
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Affiliation(s)
- Francesco Brigo
- Section of Clinical Neurology, Department of Neurological and Movement Sciences, University of Verona, Piazzale L.A. Scuro, 10, 37134, Verona, Italy,
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Jang JW, Park SY, Hong JH, Park YH, Kim JE, Kim S. Different risk factor profiles between transient global amnesia and transient ischemic attack: a large case-control study. Eur Neurol 2013; 71:19-24. [PMID: 24281363 DOI: 10.1159/000354023] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 06/23/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND The pathophysiology of transient global amnesia (TGA) is not fully understood. This study was conducted to identify the cardiovascular risk factors of TGA compared to those of transient ischemic attack (TIA) and normal controls, using a large number of subjects. In addition to the comparison of risk factors, an association between the observed cardiovascular risk factors in the current study and a pathophysiological mechanism recently investigated was speculated upon. MATERIALS AND METHODS We performed a retrospective case-control study that compared 293 TGA patients to 632 TIA patients and 293 age- and sex-matched normal controls. Demographic details and cardiovascular risk factors were carefully recorded. RESULTS TGA patients had a significantly higher prevalence of ischemic heart disease and hyperlipidemia; however, they had a lower prevalence of hypertension, diabetes mellitus, ischemic stroke and atrial fibrillation when compared to TIA patients. When compared to age- and sex-matched normal controls, TGA patients also had a significantly higher prevalence of hyperlipidemia, previous ischemic stroke and ischemic heart disease. CONCLUSION The cardiovascular risk factors identified in TGA patients in this study were different from those of previously reported studies. This disproportionate prevalence of cardiovascular risk factors may constitute possible evidence that TGA and TIA differ in their pathophysiological mechanism. In addition, some cardiovascular risk factors, such as hyperlipidemia and ischemic heart disease, should be regarded as possible risk factors of TGA.
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Affiliation(s)
- Jae-Won Jang
- Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam-si, and Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
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Auyeung M, Tsoi T, Cheung C, Fong DY, Li R, Chan JK, Lau K. Association of diffusion weighted imaging abnormalities and recurrence in transient global amnesia. J Clin Neurosci 2011; 18:531-4. [DOI: 10.1016/j.jocn.2010.08.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 05/13/2010] [Accepted: 08/02/2010] [Indexed: 10/18/2022]
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Affiliation(s)
- Thorsten Bartsch
- Department of Neurology, University Hospital Schleswig-Holstein, University of Kiel, Kiel, Germany.
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The brain-derived neurotrophic factor (BDNF) Val66Met polymorphism is not significantly correlated to Transient Global Amnesia: Preliminary results of an on-going study in Brescia Province, Italy. Neurosci Lett 2008; 443:228-31. [DOI: 10.1016/j.neulet.2008.07.082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2008] [Revised: 07/29/2008] [Accepted: 07/30/2008] [Indexed: 11/21/2022]
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Agosti C, Borroni B, Akkawi NM, De Maria G, Padovani A. Transient global amnesia and brain lesions: new hints into clinical criteria. Eur J Neurol 2008; 15:981-4. [DOI: 10.1111/j.1468-1331.2008.02250.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chen ST, Tang LM, Hsu WC, Lee TH, Ro LS, Wu YR. Clinical features, vascular risk factors, and prognosis for transient global amnesia in Chinese patients. J Stroke Cerebrovasc Dis 2007; 8:295-9. [PMID: 17895178 DOI: 10.1016/s1052-3057(99)80003-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/1998] [Accepted: 01/22/1999] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Transient global amnesia (TGA) is an intriguing clinical syndrome that has not been studied in a series of Chinese patients. METHODS From 1989 to 1995, we observed 28 consecutive patients with TGA. Their clinical characteristics, risk factors, and outcome were retrospectively reviewed and analyzed. RESULTS There were 13 men and 15 women with a mean age of 62 years (range, 39 to 76). The duration of amnesic attack ranged from 20 minutes to 24 hours (mean, 8 hours), with the majority (76%) of attacks lasting for 2 to 12 hours. In 9 (32%) of the 28 patients, the TGA was triggered by a potential precipitating factor including bathing, emotional stress, and headache. The most prominent symptom exhibited by patients during an attack was repetitive questioning, which occurred in 21 (75%) of the 28 patients. No focal neurological abnormality was noted during or after the attack. Electroencephalograms were obtained in 26 patients after experiencing TGA, which showed nonspecific findings in 6 patients and were normal in 20. In 21 patients who had cranial computed tomography scans, cortical atrophy was found in 5 (24%), focal infarction in 4 (19%), and the results were negative in 12 (57%). Hypertension was the predominant vascular risk factor (11 cases, 39%), then hyperlipidemia (7 cases, 25%), and smoking (3 cases, 11%). No vascular risk factor was found in 13 patients (46%). Recurrent TGA was found in 5 patients (18%), and stroke in 2 (7%). CONCLUSION Our study largely confirms the demographic pattern, clinical characteristics, and prognosis of TGA patients reported from the western countries. Although the cause is uncertain, TGA is a relatively benign entity.
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Affiliation(s)
- S T Chen
- Second Department of Neurology, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
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Ertas M, Bolay H, Kocasoy-Orhan E, Hanagasi H, Baykan B. Subclinical Impairment of Neuromuscular Transmission in Transient Global Amnesia. Cogn Behav Neurol 2007; 20:179-83. [PMID: 17846517 DOI: 10.1097/wnn.0b013e318051809d] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the neuromuscular transmission (NMT) of the patients with transient global amnesia (TGA) using single fiber electromyography (SFEMG). BACKGROUND The pathophysiology of TGA remains unknown and several elements support the hypothesis of a shared background with migraine. Recent studies showed that some migraineurs have subclinical abnormalities of NMT by using SFEMG. We aimed to test the patients with TGA using SFEMG. METHODS We investigated 6 patients diagnosed with TGA according to published criteria and 5 healthy volunteers with similar ages. SFEMG during voluntary contraction of the extensor digitorum communis muscle, nerve conduction studies and concentric needle electromyography were performed and 20 single fiber potential pairs were recorded from each subject and individual and mean jitter values were calculated. RESULTS Three patients with TGA showed pronounced NMT failure by SFEMG, whereas none of the controls disclosed this abnormality. The mean jitter value of TGA patients (35+/-33) was greater than that of the control subjects (25+/-15) (P=0.006). Seventeen of the 120 individual jitter values of the TGA group and only 3 (from 3 different volunteers) of the 100 individual jitter values of the control group exceeded upper normal limit (P=0.004). CONCLUSIONS These results suggest that TGA shares the same type of subclinical abnormality of NMT observed in migraine patients in recent studies.
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Affiliation(s)
- Mustafa Ertas
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Nedelmann M, Kaps M. Elevated blood pressure as a prominent finding in patients with transient global amnesia. Eur J Neurol 2007; 14:e22. [PMID: 17594310 DOI: 10.1111/j.1468-1331.2007.01846.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Taylor RA, Wu GF, Hurst RW, Kasner SE, Cucchiara BL. Transient global amnesia heralding basilar artery thrombosis. Clin Neurol Neurosurg 2005; 108:60-2. [PMID: 16311149 DOI: 10.1016/j.clineuro.2004.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2004] [Revised: 11/06/2004] [Accepted: 11/06/2004] [Indexed: 10/26/2022]
Abstract
The cause of transient global amnesia (TGA) remains controversial. Focal cerebral ischemia, seizure, venous congestion, and migraine have all been proposed as underlying mechanisms. We describe a patient presenting with typical TGA who two days later developed a posterior circulation stroke due to basilar artery occlusion. He was treated successfully with intra-arterial thrombolytic therapy. Shortly thereafter, he had recurrent basilar artery thrombosis and jugular vein thrombosis, and was found to have a mucinous adenocarcinoma believed to be causing a hypercoagulable state. We believe this case supports the hypothesis that TGA can on occasion be caused by cerebral ischemia.
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Affiliation(s)
- Robert A Taylor
- Department of Neurology, University of Pennsylvania Medical Center, Philadelphia, 19104, USA
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Ortego-Centeno N, Callejas-Rubio JL, Fernández MG, Camello MG. Transient global amnesia in a patient with high and persistent levels of antiphospholipid antibodies. Clin Rheumatol 2005; 25:407-8. [PMID: 16208431 DOI: 10.1007/s10067-005-0012-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2005] [Accepted: 03/21/2005] [Indexed: 11/29/2022]
Abstract
Cerebrovascular disease is one of the most common symptoms associated with anticardiolipin antibodies (ACA) and lupus anticoagulant (LA), usually in the form of ischemic stroke. However, many other neurologic disorders have been described in patients with antiphospholipid syndrome or ACA. So far, the precise relation between the presence of antibodies and the development of the disease in many of these cases remain unknown. Transient global amnesia (TGA) is an infrequent neurologic disturbance whose precise pathophysiology is not known. It is characterized by a sudden inability to acquire new information, usually lasting no more than 12 h, and it is not accompanied by any other focal neurological signs or symptoms. We report a patient with TGA with persistent and high levels of ACA and LA and suggest that in patients with TGA, investigation of the possible presence of ACA and/or LA may be warranted because a higher prevalence of TGA in the patients with antiphospholipidic syndrome with respect to the general population may lead to further insights into pathogenesis of neurologic disease associated with antiphospholipidic antibodies.
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Affiliation(s)
- Norberto Ortego-Centeno
- Unidad de Enfermedades Autoinmunes Sistémicas, Hospital Clínico San Cecilio, Dr. Oloriz s/n, 18012 Granada, Spain.
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Toledo M, Pujadas F, Purroy F, Lara N, Quintana M, Alvarez-Sabin J. La amnesia global transitoria recurrente, una manifestación de la enfermedad isquémica cerebrovascular. Med Clin (Barc) 2005; 125:361-5. [PMID: 16185544 DOI: 10.1157/13079167] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Transient Global Amnesia (TGA) is a self-limited anterograde memory loss related classically to transient ischemic attacks (TIA), migraine and epilepsy. This study intended to describe clinical characteristics, the vascular risk factors and the evolution of TGA and to define clinical factors associated with recurrence. PATIENTS AND METHOD Of 139 patients with TGA, 124 were followed up for a mean time of 71.9 (39) months; these patients were compared with other 124 patients with TIA. The TGA group was subdivided in 2 subgroups: Unique-TGA (98 cases): 1 episode, and recurrent-TGA (26 cases): 2 or more episodes. Recurrent-TGA were also compared with unique-TGA and the TIA groups. RESULTS The mean age of patients of the TGA group was 63 (7.96) and 58% were women. 30% had a history of migraine and 30% had anxiety. The risk of annual recurrence was 4.4%. Recurrent-TGA patients had more electroencephalographic registers showing non-epileptogenic abnormalities. The TIA group had more vascular risk factors and displayed more ischemic events during the follow-up. Recurrent-TGA patients had the same vascular risk factors as TIA patients and they also had a significantly more frequent history of stroke and trend to suffer new ischemic events than patients in the unique-TGA group. CONCLUSIONS There is no vascular pathology substrate in TGA patients, suggesting an ischemic etiology due to arteriosclerosis or cardioembolism. Patients with recurrent TGA constitute a subgroup with more vascular risk factors and an increased risk to suffer new strokes. For that reason we propose that these patients be studied as ischemic patients.
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Affiliation(s)
- Manuel Toledo
- Servicio de Neurología, Hospital Vall d'Hebron, Barcelona, Spain.
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Abstract
Transient global amnesia (TGA) is one of the most striking syndromes in clinical neurology. Despite several new hypotheses concerning TGA pathogenesis-including psychological disturbances, personality traits, and hypoxic-ischaemic origin associated with venous congestion in memory relevant structures or small vessel changes-there is no consensus about the cause. New imaging techniques, particularly diffusion-weighted imaging, open up new insights into the location of TGA pathology. Studies with dynamic venous duplex sonography confirmed the importance of jugular-vein-valve insufficiency. We review these new findings and their implications for a better understanding of this remarkable syndrome. Although we still do not have all the answers, the use of new imaging modalities, neuropsychological findings, and epidemiological data may in future help to unravel the origin of TGA.
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Pantoni L, Bertini E, Lamassa M, Pracucci G, Inzitari D. Clinical features, risk factors, and prognosis in transient global amnesia: a follow-up study. Eur J Neurol 2005; 12:350-6. [PMID: 15804264 DOI: 10.1111/j.1468-1331.2004.00982.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We previously observed a high frequency of psychopathological features in transient global amnesia (TGA). We aimed at assessing differences in risk factor profile and prognosis between TGA and transient ischemic attack (TIA) patients with a focus on aspects with possible psychopathological relevance. We studied 51 TGA patients (mean age +/- SD, 62.7 +/- 6.7 years; M/F = 24/27) and 51 control patients with TIA (mean age +/- SD, 63.8 +/- 6.7 years; M/F = 41/10) and followed them up for about 7 years. Compared with TIA controls, TGA patients more frequently had a history of psychiatric diseases (age and sex-corrected OR = 2.86, 95% CI: 1.01-8.05) and alcohol use (OR = 3.26, 95% CI: 1.10-9.66) and less frequently a history of cardiac (OR = 0.29, 95% CI: 0.11-0.76) or peripheral artery disease (OR = 0.11, 95% CI: 0.01-0.96). A family history of psychiatric diseases was reported more frequently by TGA than TIA patients (OR = 2.99, 95% CI: 1.04-8.59). On follow-up, in comparison with TIA patients, TGA patients had a significantly lower risk of combined stroke, myocardial infarct, and death (log-rank test, P = 0.0059). In the multivariate analysis, the dissimilar baseline risk factor profile explained most of the difference in prognosis between the two groups. In comparison with TIA patients, patients with TGA have more frequently a personal or family history of psychiatric diseases and a more favorable vascular risk factor profile and prognosis. These results have therapeutic implications and reinforce the hypothesis that TGA is a benign disorder.
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Affiliation(s)
- L Pantoni
- Azienda Ospedaliera Careggi, Florence, Italy.
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Benke T, Chemelli A, Lottersberger C, Waldenberger P, Karner E, Trinka E. Transient global amnesia triggered by the intracarotid amobarbital procedure. Epilepsy Behav 2005; 6:274-8. [PMID: 15710318 DOI: 10.1016/j.yebeh.2004.12.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2004] [Revised: 12/28/2004] [Accepted: 12/28/2004] [Indexed: 10/25/2022]
Abstract
The emergence of a sudden, global, and fully reversible amnestic state during an intracarotid amobarbital procedure (IAP) performed in a patient with a right temporal tumor is described. Forms of amnesia during the IAP are discussed, and it is argued that because of its appearance, the associated behavioral abnormalities, and EEG findings, this state was a transient global amnesia (TGA). In addition to other origins such as bitemporal lesions, increased barbiturate levels, seizures, and epileptic amnesia, TGA may triggered by stress or angiography during the IAP.
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Affiliation(s)
- T Benke
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria.
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Solheim O, Skeidsvoll T. Transient global amnesia may be caused by cerebral vein thrombosis. Med Hypotheses 2005; 65:1142-9. [PMID: 16061328 DOI: 10.1016/j.mehy.2005.05.042] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2005] [Revised: 05/18/2005] [Accepted: 05/19/2005] [Indexed: 11/21/2022]
Abstract
Transient global amnesia (TGA) is a disorder of unknown aetiology, characterized by sudden loss of anterograde memory, in the absence other neurological signs or symptoms, followed by complete recovery in less than 24h. Precipitating actions such as strenuous physical activity or valsalva-like manoeuvres are frequently reported. Since first described in 1958, by Fisher and Adams, the possible pathophysiology has undergone much speculation. Nonconvulsive epileptic seizures, migraine, paradoxical embolism thorough a patent foramen ovale, and transient ischemic attacks have been proposed as potential mechanisms. One of the latest hypotheses is that venous congestion causes either ischemia or induces spreading depression in the medial temporal lobes. It has been demonstrated that retrograde flow in the internal jugular veins occurs more frequently during valsalva manoeuvres in TGA patients than in controls, supporting a dysfunctional venous circulation as part of the pathogenesis. However, earlier hypotheses typically fail to explain the relatively low recurrence rate of TGA, lack of comorbidity and the relation to precipitating events. If cerebral venous hypertension was the solely cause of TGA it would presumably be much more common with very high recurrence rates among those predisposed of the condition. Structural changes observed in MRI and SPECT studies along with reports of mild cognitive impairment lasting much longer than the amnestic episodes, indicate that TGA is less transient and perhaps somewhat less benign than earlier believed. Many cases of TGA seem to be associated with factors of increased risk of cerebral venous thrombosis, such as polycythemia, antiphospholipid antibodies, venous hypertension, female sex and more. We suggest that most cases of TGA may be due to small thrombi in the deep cerebral venous system. Small venous thrombi may difficult to visualize even when using modern imaging technology. Further studies of TGA patients with for example blood analysis of D-dimer together with MR venography or CT venography could be done to evaluate this new hypothesis.
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Affiliation(s)
- Ole Solheim
- Department of Neurosurgery, University Hospital of Trondheim, St. Olavs Hospital, Olav Kyrres gt 17, N-7005 Trondheim, Norway.
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Greer DM, Schaefer PW, Schwamm LH. Unilateral temporal lobe stroke causing ischemic transient global amnesia: role for diffusion-weighted imaging in the initial evaluation. J Neuroimaging 2001; 11:317-9. [PMID: 11462302 DOI: 10.1111/j.1552-6569.2001.tb00054.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Ischemia has been proposed as a cause of transient global amnesia (TGA), but proof has been lacking. The authors performed magnetic resonance imaging on a 77-year-old woman with classic TGA at 4 hours and at 6 days after the onset of symptoms. Her initial diffusion-weighted imaging (DWI) and apparent diffusion coefficient imaging suggested an acute infarct in the left mesial temporal lobe. Follow-up T2-weighted imaging at 6 days confirmed the lesion as an ischemic infarct, despite resolution of her symptoms. DWI permits early detection of small ischemic lesions and may identify patients with ischemic TGA who should be evaluated for potential sources of emboli.
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Affiliation(s)
- D M Greer
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, USA
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Chen ST, Tang LM, Lee TH, Ro LS, Lyu RK. Transient global amnesia and amaurosis fugax in a patient with common carotid artery occlusion--a case report. Angiology 2000; 51:257-61. [PMID: 10744015 DOI: 10.1177/000331970005100311] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The etiology of transient global amnesia (TGA) is debatable. The hypothesis of a thromboembolic cause of TGA has been questioned by recent case control studies. Occlusion of the common carotid artery (CCA) is rare. Although amaurosis fugax (AF) is a hallmark of ipsilateral internal carotid artery disease, its occurrence in CCA occlusion is less known. Association of these three conditions in a patient may imply pathophysiologic significance. Here, the authors report a 76-year-old man who suffered from a spell of TGA and then several attacks of AF of the right eye. Progressive occlusion of the right CCA was documented by repeat carotid duplex scans and was finally confirmed by cerebral angiography. In this patient, the occurrence of CCA occlusion and AF implicates a vascular etiology for the event of TGA. A noninvasive carotid ultrasonographic screen may, therefore, be worthwhile for patients with TGA.
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Affiliation(s)
- S T Chen
- Second Department of Neurology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taipei, Taiwan.
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Trinka E, Pfisterer G, Unterrainer J, Staffen W, Wranek U, Löscher NW, Ladurner G. Multimodal event-related potential P3 after transient global amnesia. Eur J Neurol 2000; 7:81-5. [PMID: 10809919 DOI: 10.1046/j.1468-1331.2000.00011.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The putative generators of the event-related P3 component are still a matter of debate. There is reasonable evidence that the mesial temporal lobe structures are crucial in the generation of event-related potentials. Transient global amnesia (TGA) is characterized by anterograde and retrograde amnesia without neurological deficits in which a temporal hypoperfusion is the most likely pathomechanism. The aim of this study is to evaluate a possible delay in the P3 latency in a cohort of patients with TGA (n = 18). We used classic oddball paradigms with visual and auditory stimuli. The P3 latencies were compared to 18 age-matched patients with transient ischaemic attacks (TIAs) in the carotid artery territory and 23 age-matched controls. The mean age of the patients was 60.1 years (SD 14.1), in the TIA group 64.7 (SD 12.1) and 57.7 (SD 10.1) in the controls; the mean time interval between onset of TGA symptoms and performance of P3 investigations was 4.3 days (range 1-7 days); and the mean latencies measured at the vertex (Cz electrode) were 422.9 ms (SD 44.6) for the TGA patients, 436.4 ms (SD 62.1) for the TIA group, and 409.3 ms (SD 48.5) for the controls in the visual paradigm and 371.7 ms (SD 41.7), 399.7 ms (SD 51.2) and 385.3 ms (SD 46.5) in the auditory paradigm for the TGA, the TIA and the control groups. The P-values were not significant. These results suggest different neuronal networks in the generation of scalp P3 from those responsible for the disturbance of episodic memory in TGA.
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Affiliation(s)
- E Trinka
- Department of Neurology, University Hospital Innsbruck; Institute of Psychology, University of Salzburg, Austria.
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Warren JD, Chatterton B, Thompson PD. A SPECT study of the anatomy of transient global amnesia. J Clin Neurosci 2000; 7:57-9. [PMID: 10847653 DOI: 10.1054/jocn.1998.0129] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This report describes single photon emission tomography (SPECT) evidence of transient, relative hypoperfusion of the right basal ganglia and left temporal lobe in a 60-year-old man studied during the acute phase of classical transient global amnesia (TGA). The findings are interpreted in the light of previous reports indicating that involvement of the right hemisphere or both cerebral hemispheres consistently predicts severe retrograde amnesia, in addition to the typical loss of anterograde memory observed during TGA. These deficits involving the right hemisphere and left temporal lobe may reflect disruption of circuits mediating episodic memory retrieval and memory encoding, respectively.
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Affiliation(s)
- J D Warren
- Department of Neurology, Royal Adelaide Hospital, South Australia, Australia
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Abstract
Aging influences cerebrovascular disease expression by a variety of mechanisms. Age-related changes in cerebral autoregulation, cellular metabolism, the blood-brain barrier, and autonomic function may leave the cerebrovascular system vulnerable to injury. Certain cerebrovascular disease, such as atrial fibrillation, watershed infarctions, carotid artery atherosclerosis, cerebral hemorrhages, subdural hematomas, and transient global amnesia manifest in the elderly. Vascular dementia and white matter disease are better understood with newer neuroimaging studies, careful neuropsychological and histopathologic examinations. Atherosclerosis and cerebral amyloid angiopathy may have larger roles than previously understood in Alzheimer's disease.
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Affiliation(s)
- J Y Choi
- Department of Neurology, Barnes-Jewish Hospital, Washington University, St. Louis, Missouri 63110-1093, USA
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Lauria G, Gentile M, Fassetta G, Casetta I, Caneve G. Transient global amnesia and transient ischemic attack: a community-based case-control study. Acta Neurol Scand 1998; 97:381-5. [PMID: 9669471 DOI: 10.1111/j.1600-0404.1998.tb05970.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Few case-control studies of first-ever transient global amnesia (TGA), transient ischemic attack (TIA) and normal controls have been performed to date. We aimed to assess the prevalence of cerebrovascular risk factors in a well defined population of TGA patients. MATERIAL AND METHODS We undertook a retrospective and prospective community-based case-control study of 170 first-ever TGA, 170 first-ever TIA and 170 normal controls. RESULTS Age-matched analysis revealed that TGA cases had a significantly lower prevalence of atrial fibrillation and diabetes mellitus than TIA controls. The prevalence of cigarette smoking and diabetes mellitus was significantly higher in normal controls than in TGA cases. CONCLUSION Our community-based case-control study showed that atrial fibrillation and diabetes mellitus, two important risk factors for cerebrovascular disease, were significantly more common in the TIA group than in the TGA one. These results make the thromboembolic pathogenesis of TGA unlikely.
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Affiliation(s)
- G Lauria
- Institute of Clinical Neurology, University of Ferrara, Italy
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Sakashita Y, Kanai M, Sugimoto T, Taki S, Takamori M. Changes in cerebral blood flow and vasoreactivity in response to acetazolamide in patients with transient global amnesia. J Neurol Neurosurg Psychiatry 1997; 63:605-10. [PMID: 9408101 PMCID: PMC2169813 DOI: 10.1136/jnnp.63.5.605] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Previous reports about changes in cerebral blood flow (CBF) in transient global amnesia disclosed decreased flow in some parts of the brain. However, CBF analyses in most reports were qualitative but not quantitative. The purpose of this study was to determine changes in CBF in transient global amnesia. METHODS The CBF was measured and the vasoreactive response to acetazolamide was evaluated in six patients with transient global amnesia using technetium-99m hexamethylpropylene amine oxime single-photon emission computed tomography (SPECT). The CBF was measured during an attack in two patients and soon after an attack in the other four. About one month later, CBF was re-evaluated in each patient. RESULTS Two patients examined during an attack and one patient examined five hours after an attack had increased blood flow in the occipital cortex and cerebellum. Three patients examined at six to 10 hours after an attack had decreased blood flow in the thalamus, cerebellum, or putamen. These abnormalities of blood flow almost disappeared in all patients one month after onset. The vasodilatory response to acetazolamide, which was evaluated initially using SPECT, was poor in areas of increased blood flow. By the second evaluation of CBF with acetazolamide, the vasodilatory response had returned to normal. CONCLUSIONS In a patient with transient global amnesia, CBF increased in the vertebrobasilar territory during the attack and decreased afterwards. The vasodilatory response to acetazolamide may be impaired in the parts of the brain with increased blood flow. It is suggested that transient global amnesia is distinct from migraine but may share the same underlying mechanism.
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Affiliation(s)
- Y Sakashita
- Department of Neurology, Tonami General Hospital, Toyama, Japan
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Lauria G, Gentile M, Fassetta G, Casetta I, Caneve G. Incidence of transient global amnesia in the Belluno province, Italy: 1985 through 1995. Results of a community-based study. Acta Neurol Scand 1997; 95:303-10. [PMID: 9188907 DOI: 10.1111/j.1600-0404.1997.tb00215.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION We sought to determine the incidence rate of all the new cases of first-ever-in-a-lifetime transient global amnesia in the Belluno province, Italy. Only two prospective epidemiological studies on TGA incidence have been performed to date, non in Italy. Our study aimed to provide reliable and comparable information on TGA incidence. MATERIAL AND METHODS We undertook a prospective population-based study in the territory of the province of Bulluno, Italy, between June 1, 1992 and December 31, 1995. We also retrospectively reviewed the clinical records of all the patients with a diagnosis of amnesia seen in the hospitals of the study area from January 1, 1985 through May 31, 1992. RESULTS During the prospective study period we identified 77 patients who experienced a first-ever TGA. The crude annual incidence rate was 10.4/100,000 (9.35/100,000 for men and 11.37/100,000 for women). After adjustment to the European population, the incidence rate decreased to 8.60/100,000 per year. The crude annual incidence rate during the retrospective study period was 5.81/100,000. The demographic and clinical features of the two groups did not differ one to the other. CONCLUSIONS The incidence rate of first-ever TGA registered in the province of Belluno, Italy, was closely similar to that reported in Turku, Finland and confirms that TGA is more common than has been usually proposed. We emphasize the usefulness of prospective, rather than retrospective, epidemiological studies for research on TGA.
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Affiliation(s)
- G Lauria
- Section of Neuroepidemiology, University of Ferrara, Italy
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Abstract
Two cases of transient global amnesia (TGA) in a 16-year-old boy and in a 13-year-old girl are reported; both occurred during competitive sport and were associated with migraine. TGA in young people could provide crucial information on the still equivocal pathogenesis, a vascular thromboembolic hypothesis being untenable in such cases. A migrainous mechanism is likely to underlie TGA in young people and "pure' TGA in general. TIA or stroke, like epilepsy or other pathological conditions, should concern the differential diagnosis of transient amnestic episodes rather than the pathogenesis of TGA.
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Affiliation(s)
- L Tosi
- Servizio di Neurologia, Ospedale Sacro Cuore, Verona, Italy
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