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Transient Global Amnesia as the Sole Presentation of an Acute Stroke in the Left Cingulate Gyrus. Case Rep Neurol Med 2019; 2019:4810629. [PMID: 30915247 PMCID: PMC6402209 DOI: 10.1155/2019/4810629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 01/15/2019] [Accepted: 01/23/2019] [Indexed: 11/20/2022] Open
Abstract
We discuss a patient who presented to our hospital with signs, symptoms, and clinical course consistent with transient global amnesia (TGA). Her hospital work-up was overall unremarkable except for the presence of a diffusion weighted imaging (DWI) abnormality on MRI suggestive of acute infarction in the left cingulate gyrus. Symptoms quickly resolved, and she was discharged home in stable condition. While the etiology of TGA remains controversial, in discussing this case and the current literature we hope to provide further data supporting the possibility of an underlying ischemic process, as well as help better illustrate the neurologic structures involved.
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Wang J, Ke J, Zhou C, Yin C. Amnesia due to the Injury of Papez Circuit Following Isolated Fornix Column Infarction. J Stroke Cerebrovasc Dis 2018; 27:1431-1433. [PMID: 29395646 DOI: 10.1016/j.jstrokecerebrovasdis.2017.12.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 12/18/2017] [Accepted: 12/23/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Jianping Wang
- Department of Neurology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China.
| | - Junji Ke
- Department of Neurology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Chenguang Zhou
- Department of Neurology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Chunmao Yin
- Department of Neurology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China
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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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Naldi F, Baiardi S, Guarino M, Spinardi L, Cirignotta F, Stracciari A. Posterior hippocampal stroke presenting with transient global amnesia. Neurocase 2017; 23:22-25. [PMID: 28004602 DOI: 10.1080/13554794.2016.1270329] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The acute onset of isolated amnesia is an intriguing challenge for neurologist, because the lack of associated signs can be misleading for diagnosis. The most common cause is transient global amnesia (TGA), a benign condition, but rarely it results from abuse of substance/alcohol or cerebrovascular diseases. In the latter, the brain region involved is the hippocampus. We describe a patient with presenting symptoms of TGA, but affected by an ischemic hippocampal stroke. The computed tomography angiography helped the etiologic diagnosis showing an hemodynamic stenosis of the posterior P2P segment. Interestingly, neuropsychological features were consistent with those found in patients suffering TGA.
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Affiliation(s)
- Federica Naldi
- a Neurology Unit , S. Orsola-Malpighi University Hospital , Bologna , Italy
| | - Simone Baiardi
- a Neurology Unit , S. Orsola-Malpighi University Hospital , Bologna , Italy.,b Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy
| | - Maria Guarino
- a Neurology Unit , S. Orsola-Malpighi University Hospital , Bologna , Italy
| | - Luca Spinardi
- c Diagnostic and Interventional Neuroradiology Unit , S. Orsola-Malpighi Hospital , Bologna , Italy
| | - Fabio Cirignotta
- a Neurology Unit , S. Orsola-Malpighi University Hospital , Bologna , Italy.,b Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy
| | - Andrea Stracciari
- a Neurology Unit , S. Orsola-Malpighi University Hospital , Bologna , Italy
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Transient global amnesia associated with an acute infarction at the cingulate gyrus. Case Rep Neurol Med 2014; 2014:418180. [PMID: 25126430 PMCID: PMC4122058 DOI: 10.1155/2014/418180] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 07/01/2014] [Indexed: 11/18/2022] Open
Abstract
Background. Transient global amnesia (TGA) is a syndrome of sudden, unexplained isolated short-term memory loss. In the majority of TGA cases, no causes can be identified and neuroimaging, CSF studies and EEG are usually normal. We present a patient with TGA associated with a small acute infarct at the cingulate gyrus. Case Report. The patient, a 62 year-old man, developed two episodes of TGA. He had hypertension and hypercholesterolemia. He was found to have an acute ischemic stroke of small size (15 mm of maximal diameter) at the right cerebral cingulate gyrus diagnosed on brain magnetic resonance imaging. No lesions involving other limbic system structures such as thalamus, fornix, corpus callosum, or hippocampal structures were seen. The remainder of the examination was normal. Conclusion. Unilateral ischemic lesions of limbic system structures may result in TGA. We must bear in mind that TGA can be an associated clinical disorder of cingulate gyrus infarct.
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Abstract
Transient amnesic syndromes are striking clinical phenomena that are commonly encountered by physicians in acute medical settings. Diagnosis of such syndromes can be challenging, and their causes have been debated for over 50 years. Critical clinical distinctions, such as between transient global amnesia (TGA) and transient epileptic amnesia (TEA), as well as important clues to the underlying pathophysiology, have recently been revealed. TGA is characterized by the sudden onset of a profound anterograde and retrograde amnesia that lasts for up to 24 h, with neuroimaging after an acute TGA event showing transient perturbation of specific hippocampal circuits that are involved in memory processing. Some cases of transient amnesia are attributable to focal seizure activity and are termed TEA, which has a clinical presentation similar to that of TGA, but can be distinguished from the latter by the brevity and frequency of amnesic attacks. Moreover, TEA carries a risk of persistent memory impairment that can be mistaken for dementia. Here, we summarize clinically relevant aspects of transient amnesic syndromes, giving practical recommendations for diagnosis and patient management. We describe results from imaging and epidemiological studies that have shed light on the functional anatomy and pathophysiological mechanisms underlying these conditions.
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