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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: 3] [Impact Index Per Article: 1.5] [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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Hodel J, Leclerc X, Zuber M, Gerber S, Besson P, Marcaud V, Roubeau V, Brasme H, Ganzoui I, Ducreux D, Pruvo JP, Bertoux M, Zins M, Lopes R. Structural Connectivity and Cortical Thickness Alterations in Transient Global Amnesia. AJNR Am J Neuroradiol 2020; 41:798-803. [PMID: 32381542 DOI: 10.3174/ajnr.a6530] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 03/12/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Transient global amnesia (TGA) is a sudden onset of anterograde and retrograde amnesia. We aimed to assess differences in terms of cortical thickness and structural brain connectome between patients with TGA (at acute and delayed postrecovery stages) and matched controls. MATERIALS AND METHODS We report on 18 consecutive patients with TGA who underwent 3T MR imaging, including DTI and MPRAGE sequences, at the acute (mean delay postonset: 44 hours) and delayed post-recovery (mean delay: 35 days) stages. Structural connectome was assessed in patients with TGA and in 18 age- and sex-matched controls by using probabilistic fiber- tracking and segmentation of 164 cortical/subcortical structures ("nodes"). Connectivity graphs were computed and global network metrics were calculated. Network-based statistical analysis (NBS) was applied to compare patients with TGA at each stage with controls. We also compared cortical thickness between patients with TGA and healthy controls. RESULTS Global network metrics were not altered in patients with TGA. NBS-analysis showed structural connectome alterations in patients with TGA compared with controls, in core regions involving the limbic network, with 113 nodes and 114 connections (33 left intrahemispheric, 31 right intrahemispheric, and 50 interhemispheric connections) showing significantly decreased structural connectivity (P < .05 NBS corrected, t-values ranging from 3.03 to 8.73). Lower cortical thickness compared with controls was associated with these structural alterations in patients with TGA, involving the orbitofrontal, cingulate, and inferior temporal cortices. All the abnormalities were visible at both acute and delayed postrecovery stages. CONCLUSIONS Our preliminary study suggests there are structural abnormalities of the limbic network in patients with TGA compared with controls, including decreased structural connectivity and cortical thickness.
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Affiliation(s)
- J Hodel
- From the Departments of Radiology (J.H., S.G., I.G., M.Z.)
| | - X Leclerc
- Department of Neuroradiology (X.L., J.-P.P., R.L.), Roger Salengro Hospital, Lille, France
| | - M Zuber
- Neurology (M.Z., V.M., V.R., H.B.), Saint Joseph Hospital, Paris, France.,INSERM UMR S919 (M.Z.), Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - S Gerber
- From the Departments of Radiology (J.H., S.G., I.G., M.Z.)
| | - P Besson
- Department of Radiology (P.B.), Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - V Marcaud
- Neurology (M.Z., V.M., V.R., H.B.), Saint Joseph Hospital, Paris, France
| | - V Roubeau
- Neurology (M.Z., V.M., V.R., H.B.), Saint Joseph Hospital, Paris, France
| | - H Brasme
- Neurology (M.Z., V.M., V.R., H.B.), Saint Joseph Hospital, Paris, France
| | - I Ganzoui
- From the Departments of Radiology (J.H., S.G., I.G., M.Z.)
| | - D Ducreux
- Department of Neuroradiology (D.D.), Bicêtre Hospital, Kremlin-Bicêtre, France
| | - J-P Pruvo
- Department of Neuroradiology (X.L., J.-P.P., R.L.), Roger Salengro Hospital, Lille, France
| | - M Bertoux
- University of Lille (M.B., R.L.), Inserm U1171, CHU Lille, F-59000, Lille, France
| | - M Zins
- From the Departments of Radiology (J.H., S.G., I.G., M.Z.)
| | - R Lopes
- Department of Neuroradiology (X.L., J.-P.P., R.L.), Roger Salengro Hospital, Lille, France.,University of Lille (M.B., R.L.), Inserm U1171, CHU Lille, F-59000, Lille, France
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Kim SH, Park YH, Kim S, Kim JS. Impaired Smooth Pursuit During Transient Global Amnesia. J Clin Neurol 2019; 15:301-307. [PMID: 31286700 PMCID: PMC6620448 DOI: 10.3988/jcn.2019.15.3.301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 12/27/2018] [Accepted: 12/27/2018] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose During transient global amnesia (TGA), selective impairment of episodic memory is assumed to occur due to alteration in the neuronal network between the hippocampus and parietooccipital cortices that also include a hub for smooth pursuit (SP) eye movements. This study aimed to determine whether SP is impaired during TGA, and to identify any anatomical and functional linkage present between the oculomotor and memory systems. Methods Within a median of 1.0 day of TGA, horizontal SP was evaluated in 145 patients with a target moving at peak velocities of 10°/s and 20°/s. The average SP gains of patients were compared with those of the age-matched controls. Results The patients with TGA showed lower SP gains in both directions for both peak target velocities. While the normal controls showed symmetric SP in the rightward and leftward directions, in the TGA patients the SP gain was lower during rightward than leftward SP regardless of bilaterality or the side of the lesions. Conclusions The cortical regions processing information about visual motion appeared to be affected during or soon after an amnestic episode of TGA, and more so in the right hemisphere. This means that disturbed processing of dynamic visual information may be related to the impaired spatial orientation observed during TGA.
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Affiliation(s)
- Sung-Hee Kim
- Department of Neurology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Young Ho Park
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Korea
| | - SangYun Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Korea
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Kim HC, Lee BI, Kim SE, Park KM. Cortical morphology in patients with transient global amnesia. Brain Behav 2017; 7:e00872. [PMID: 29299390 PMCID: PMC5745250 DOI: 10.1002/brb3.872] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 10/02/2017] [Accepted: 10/09/2017] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE This study evaluated alterations in cortical morphology in patients with transient global amnesia (TGA). MATERIALS AND METHODS Diagnoses of TGA occurred at our hospital. Evaluation involved a structured interview to obtain clinical information and a brain magnetic resonance imaging scan. We analyzed whole-brain T1-weighted MRI data using FreeSurfer 5.1. Measures of cortical morphology, such as thickness, surface area, volume, and curvature were compared between patients with TGA and healthy controls. We also quantified the correlations between clinical variables and each measure of abnormal cortical morphology. RESULTS Seventy patients met the inclusion criteria. Compared to healthy controls, patients with TGA had significant alterations in cortical thickness in several regions of bilateral hemisphere. Moreover, several regions of cortical volumes in left hemisphere were significantly different between patients with TGA and healthy controls. In addition, there were significant correlations between the durations of episodes and cortical thickness, especially in the parietal cortex. However, there were no differences between groups in other measures of cortical morphology, including surface area and curvatures. CONCLUSIONS We observed significant alterations in cortical morphology in patients with TGA; these alterations are implicated in the pathogenesis of TGA.
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Affiliation(s)
- Hyung Chan Kim
- Department of Neurology Haeundae Paik Hospital Inje University College of Medicine Busan Korea
| | - Byung In Lee
- Department of Neurology Haeundae Paik Hospital Inje University College of Medicine Busan Korea
| | - Sung Eun Kim
- Department of Neurology Haeundae Paik Hospital Inje University College of Medicine Busan Korea
| | - Kang Min Park
- Department of Neurology Haeundae Paik Hospital Inje University College of Medicine Busan Korea
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Decreased Metabolism in the Posterior Medial Network with Concomitantly Increased Metabolism in the Anterior Temporal Network During Transient Global Amnesia. Brain Topogr 2017; 31:468-476. [PMID: 29038979 DOI: 10.1007/s10548-017-0602-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 10/11/2017] [Indexed: 01/30/2023]
Abstract
Perturbation of corticohippocampal circuits is a key step in the pathogenesis of transient global amnesia. We evaluated the spatial distribution of altered cerebral metabolism to determine the location of the corticohippocampal circuits perturbed during the acute stage of transient global amnesia. A consecutive series of 12 patients with transient global amnesia who underwent 18F-fluorodeoxyglucose positron emission tomography within 3 days after symptom onset was identified. We used statistical parametric mapping with two contrasts to identify regions of decreased and increased brain metabolism in transient global amnesia patients compared with 25 age-matched controls. Transient global amnesia patients showed hypometabolic clusters in the left temporal and bilateral parieto-occipital regions that belong to the posterior medial network as well as, hypermetabolic clusters in the bilateral inferior frontal regions that belong to the anterior temporal network. The posterior medial and anterior temporal networks are the two main corticohippocampal circuits involved in memory-guided behavior. Decreased metabolism in the posterior medial network might explain the impairment of episodic memory observed during the acute stage of transient global amnesia. Concomitant increased metabolism within the anterior temporal network might occur as a compensatory mechanism.
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Kim BS, Cho SS, Choi JY, Kim YH. Transient global amnesia: a study with Tc-99m ECD SPECT shortly after symptom onset and after recovery. Diagn Interv Radiol 2017; 22:476-80. [PMID: 27535207 DOI: 10.5152/dir.2016.15487] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Transient global amnesia (TGA) is characterized by sudden loss of memory of recent events, transient inability to retain new information, and retrograde amnesia. We investigated the changes of regional cerebral blood flow in patients with TGA shortly after symptom onset and after recovery using Tc-99m-ethyl cysteinate dimer single-photon emission computed tomography (Tc-99m ECD SPECT) and statistical parametric mapping (SPM) analysis. METHODS Six right-handed patients with TGA were studied using Tc-99m ECD SPECT shortly after symptom onset and after recovery. As a control group, six healthy individuals were also studied. Images were analyzed using SPM8 using voxel-based analysis to estimate the differences between TGA patients and controls. RESULTS There was significant hypoperfusion in the left hippocampus, left thalamus, and bilateral cerebellum. In the follow-up SPECT scan, hypoperfusion in hippocampus and thalamus were restored, while hypoperfusion was noted in the temporoparietal region. CONCLUSION Our results suggest that the underlying mechanism of TGA may be temporary ischemia in the hippocampus and thalamus. There was significant restoration of perfusion in the hippocampus and thalamus after recovery from TGA.
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Affiliation(s)
- Bom Sahn Kim
- Department of Nuclear Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
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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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Left dominance of EEG abnormalities in patients with transient global amnesia. Seizure 2014; 23:825-9. [DOI: 10.1016/j.seizure.2014.06.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 06/22/2014] [Accepted: 06/25/2014] [Indexed: 11/20/2022] Open
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Awad AM, Marder E, Milo R, Stüve O. Multiple sclerosis and chronic cerebrospinal venous insufficiency: a critical review. Ther Adv Neurol Disord 2011; 4:231-5. [PMID: 21765873 DOI: 10.1177/1756285611405565] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Chronic cerebrospinal venous insufficiency (CCSVI) was recently proposed as a contributing factor in the pathology of multiple sclerosis. This concept has gained remarkable attention, partly because endovascular neurointervention has been suggested as a treatment strategy. This review summarizes available evidence and provides a critical analysis of the published data. Currently, there is inconclusive evidence to support CCSVI as an etiological factor in patients with multiple sclerosis. Endovascular procedures should not be undertaken outside of controlled clinical trials.
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Affiliation(s)
- Amer M Awad
- Baton Rouge Neurology Associates, Baton Rouge General Medical Center, 3600 Florida Blvd, Baton Rouge, LA 70806, USA
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Affiliation(s)
- Thorsten Bartsch
- Department of Neurology, University Hospital Schleswig-Holstein, University of Kiel, Kiel, Germany.
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