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Jovanovic ZB, Pavlovic AM, Vujisic Tesic BP, Pekmezovic TP, Kostic Boricic MV, Cvitan EZ, Covickovic Sternic NM. Comprehensive Ultrasound Assessment of the Craniocervical Circulation in Transient Global Amnesia. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:479-486. [PMID: 28850691 DOI: 10.1002/jum.14355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 05/12/2017] [Accepted: 05/19/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Structural changes and metabolic stress have been reported on diffusion-weighted magnetic resonance imaging in the cornu ammonis 1 area of the hippocampus in patients with transient global amnesia (TGA), but a consensus on pathogenesis is still lacking. The aim of our study was to perform a comprehensive ultrasound analysis of the cerebrovascular circulation in our population of patients with TGA. METHODS One hundred patients with TGA and 50 age- and sex-matched control participants underwent ultrasound examinations of the cervicocranial circulation. RESULTS The most significant risk factor for TGA was arterial hypertension (P < .01). There were no significant atherosclerotic lesions on the large arteries of the neck (mean internal carotid artery stenosis ± SD, 28.7% ± 11.7%) or on the large intracerebral arteries (good structural and hemodynamic status; P > .05). Rarely detected microembolic signals or a right-left cardiopulmonary shunt excluded an emboligenic mechanism of TGA (P > .05). The internal jugular vein valves were incompetent in 54% of patients with TGA, and this condition was associated with an increased risk of TGA (odds ratio, 4.16; 95% confidence interval, 1.91-9.04). The mean values of the breath holding index and pulsatility index, as parameters of small-vessel function, were within normal ranges and without differences between the TGA and control groups (P > .05). CONCLUSIONS Our ultrasound examination did not detect significant structural atherosclerotic changes of cervicocranial arteries, and an emboligenic mechanism was excluded. Only a significant rise of blood pressure in TGA and significant valvular insufficiency of the internal jugular vein were established. New research should clarify whether these simultaneous functional circulatory changes have relevance for metabolic stress in the cornu ammonis of the hippocampus.
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Affiliation(s)
- Zagorka B Jovanovic
- Neurology Clinic, Institute of Cardiology University of Belgrade, Faculty of Medicine, Clinical Center of Serbia, Belgrade, Serbia
| | - Aleksandra M Pavlovic
- Neurology Clinic, Institute of Cardiology University of Belgrade, Faculty of Medicine, Clinical Center of Serbia, Belgrade, Serbia
| | - Bosiljka P Vujisic Tesic
- Institute of Cardiology, University of Belgrade, Faculty of Medicine, Clinical Center of Serbia, Belgrade, Serbia
| | - Tatjana P Pekmezovic
- Neurology Clinic, Institute of Cardiology University of Belgrade, Faculty of Medicine, Clinical Center of Serbia, Belgrade, Serbia
| | - Marija V Kostic Boricic
- Institute of Cardiology, University of Belgrade, Faculty of Medicine, Clinical Center of Serbia, Belgrade, Serbia
| | - Edita Z Cvitan
- Neurology Clinic, Institute of Cardiology University of Belgrade, Faculty of Medicine, Clinical Center of Serbia, Belgrade, Serbia
| | - Nadezda M Covickovic Sternic
- Neurology Clinic, Institute of Cardiology University of Belgrade, Faculty of Medicine, Clinical Center of Serbia, Belgrade, Serbia
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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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Yang ST, Rodriguez-Hernandez A, Walker EJ, Young WL, Su H, Lawton MT. Adult mouse venous hypertension model: common carotid artery to external jugular vein anastomosis. J Vis Exp 2015:50472. [PMID: 25650793 DOI: 10.3791/50472] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The understanding of the pathophysiology of brain arteriovenous malformations and arteriovenous fistulas has improved thanks to animal models. A rat model creating an artificial fistula between the common carotid artery (CCA) and the external jugular vein (EJV) has been widely described and proved technically feasible. This construct provokes a consistent cerebral venous hypertension (CVH), and therefore has helped studying the contribution of venous hypertension to formation, clinical symptoms, and prognosis of brain AVMs and dural AVFs. Equivalent mice models have been only scarcely described and have shown trouble with stenosis of the fistula. An established murine model would allow the study of not only pathophysiology but also potential genetic therapies for these cerebrovascular diseases. We present a model of arteriovenous fistula that produces a durable intracranial venous hypertension in the mouse. Microsurgical anastomosis of the murine CCA and EJV can be difficult due to diminutive anatomy and frequently result in a non-patent fistula. In this step-by-step protocol we address all the important challenges encountered during this procedure. Avoiding excessive retraction of the vein during the exposure, using 11-0 sutures instead of 10-0, and making a carefully planned end-to-side anastomosis are some of the critical steps. Although this method requires advanced microsurgical skills and a longer learning curve that the equivalent in the rat, it can be consistently developed. This novel model has been designed to integrate transgenic mouse techniques with a previously well-established experimental system that has proved useful to study brain AVMs and dural AVFs. By opening the possibility of using transgenic mice, a broader spectrum of valid models can be achieved and genetic treatments can also be tested. The experimental construct could also be further adapted to the study of other cerebrovascular diseases related with venous hypertension such as migraine, transient global amnesia, transient monocular blindness, etc.
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Affiliation(s)
- Shun-Tai Yang
- Department of Anesthesia and Perioperative Care and Center for Cerebrovascular Research, University of California, San Francisco
| | | | - Espen J Walker
- Department of Anesthesia and Perioperative Care and Center for Cerebrovascular Research, University of California, San Francisco
| | - William L Young
- Department of Anesthesia and Perioperative Care and Center for Cerebrovascular Research, University of California, San Francisco; Department of Neurological Surgery, University of California, San Francisco; Department of Neurology, University of California, San Francisco
| | - Hua Su
- Department of Anesthesia and Perioperative Care and Center for Cerebrovascular Research, University of California, San Francisco
| | - Michael T Lawton
- Department of Neurological Surgery, University of California, San Francisco;
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Uttner I, Weber S, Freund W, Schmitz B, Ramspott M, Huber R. Transient Global Amnesia – Full Recovery without Persistent Cognitive Impairment. Eur Neurol 2007; 58:146-51. [PMID: 17622720 DOI: 10.1159/000104715] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2007] [Accepted: 02/09/2007] [Indexed: 11/19/2022]
Abstract
Transient global amnesia (TGA) is a clinical syndrome of unknown etiology characterized by sudden onset anterograde amnesia, which was thought to resolve completely. However, some authors have also suggested permanent memory impairment. It is unclear whether these results reflect a true persistent damage or a simply too short assessment interval in the context of a prolonged recovery phase after TGA. To evaluate the cognitive long-term outcome, 16 patients who had suffered from TGA at a mean of 3 years before and 15 healthy controls underwent a comprehensive neuropsychological test battery. No significant differences between patients' and controls' cognitive performance were found, irrespectively of the analyzed neuropsychological domain. Therefore we hypothesize that TGA usually does not cause persistent cognitive deficits due to a generally transient and prognostic benign character.
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Affiliation(s)
- I Uttner
- Department of Neurology, University of Ulm, Ulm, Germany.
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