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Werner R, Ekstrom A, Kureck I, Wöhrle JC. Vertebral artery hypoplasia and hemodynamic impairment in transient global amnesia: a case control study. Front Neurol 2024; 15:1398352. [PMID: 38784899 PMCID: PMC11112006 DOI: 10.3389/fneur.2024.1398352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 04/17/2024] [Indexed: 05/25/2024] Open
Abstract
Introduction The aetiology of transient global amnesia (TGA) is still a matter of debate. Besides ischemia of the mesial temporal lobe including the hippocampus, migraine-like mechanisms, epileptic seizures affecting mnestic structures, or venous congestion in the (para) hippocampal area due to jugular vein insufficiency have been discussed. We assessed the diameters of the intracranial arteries of TGA patients compared to controls to identify differences that support the hypothesis of reduced hippocampal perfusion as a pivotal factor in the pathophysiology of TGA. Methods We reviewed magnetic resonance imaging time of flight angiographies (TOF-MRA) that were acquired during in-patient treatment of 206 patients with acute TGA. Results The diameters of the vertebral artery (VA) in the V4 segment, the proximal basilar artery, and the internal carotid arteries were measured manually. We compared the findings with TOF-MRA images of an age and sex matched control group of neurological patients without known cerebrovascular pathology. In TGA patients the diameter of the right VA was significantly (p < 0.01) smaller compared to controls (2.09 mm vs. 2.35 mm). There were no significant differences in the diameters of the other vessels. Only the fetal variant of the posterior cerebral artery was slightly more common in TGA. Discussion The smaller diameter (hypoplasia) of the right VA supports the hypothesis of a contribution of hemodynamic factors to the pathophysiology of TGA. The fact that hypoplasia represents a congenital condition might be the explanation why previous studies failed to find an increased rate of the classical (acquired) vascular risk factors.
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Affiliation(s)
- Ralph Werner
- Neurologie und Stroke Unit, Katholisches Klinikum Koblenz-Montabaur, Koblenz, Germany
| | - Alexandra Ekstrom
- Neurologie und Stroke Unit, Katholisches Klinikum Koblenz-Montabaur, Koblenz, Germany
- Neurologie, Klinische Neurophysiologie und Stroke Unit, Unfallklinik Murnau, Murnau am Staffelsee, Germany
| | - Ingo Kureck
- Klinik für Diagnostische und Interventionelle Radiologie/Nuklearmedizin, Katholisches Klinikum Koblenz-Montabaur, Koblenz, Germany
- Radiologisches Institut Dr. von Essen, Koblenz, Germany
| | - Johannes C. Wöhrle
- Neurologie und Stroke Unit, Katholisches Klinikum Koblenz-Montabaur, Koblenz, Germany
- Neurologische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
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Cho S, Lee SH, Lee HJ, Chu MK, Kim WJ, Heo K, Kim KM. Changes in heart rate variability over time from symptom onset of transient global amnesia. Sci Rep 2024; 14:6944. [PMID: 38521821 PMCID: PMC10960858 DOI: 10.1038/s41598-024-57546-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 03/19/2024] [Indexed: 03/25/2024] Open
Abstract
Transient global amnesia (TGA) often involves precipitating events associated with changes in autonomic nervous system (ANS), and heart rate variability (HRV) reflects the ANS state. This study aimed to investigate HRV changes after TGA. A retrospective analysis of HRV included patients diagnosed with TGA between January 2015 and May 2020. The time and frequency domains of HRV were compared among three groups: early (< 1 week after TGA, n = 19), late (1-4 weeks after TGA, n = 38), and healthy control (HC, n = 19). The Pearson's correlation between time and time-domain HRV was also examined. The standard deviation of NN intervals (SDNN) (early, 47.2; late, 35.5; HC, 41.5; p = 0.033) and root mean square of successive RR interval differences (RMSSD) (early, 38.5; late, 21.3; HC, 31.0; p = 0.006) differed significantly among the three groups. Post-hoc analysis showed statistically significant differences only in the early and late groups in both SDNN (p = 0.032) and RMSSD (p = 0.006) values. However, the frequency domain with total power, low-frequency and high-frequency powers, and low-frequency/high-frequency ratio did not differ. SDNN (Pearson correlation coefficient =- 0.396, p = 0.002) and RMSSD (Pearson correlation coefficient =- 0.406, p = 0.002) were negatively correlated with time after TGA. Changes in HRV occurred over time after the onset of TGA, with the pattern showing an increase in the first week and then a decrease within 4 weeks.
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Affiliation(s)
- Soomi Cho
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Sue Hyun Lee
- Department of Neurology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Hye Jeong Lee
- Department of Neurology, Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Republic of Korea
| | - Min Kyung Chu
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Won-Joo Kim
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyoung Heo
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Kyung Min Kim
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Wu B, Wang HJ, Yang XP, Zhong ZH. The Influence of Preoperative Waiting Time on Anxiety and Pain Levels in Outpatient Surgery for Breast Diseases. J Patient Saf 2024; 20:105-109. [PMID: 38147062 DOI: 10.1097/pts.0000000000001190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
OBJECTIVE This study aims to examine the effects of different preoperative waiting times on anxiety and pain levels in patients undergoing outpatient surgery for breast diseases, providing insights for clinical interventions during the perioperative phase. METHODS Patients who underwent outpatient surgery at a hospital breast center in Ningbo between January 2021 and December 2021 were selected. Their anxiety levels at the time when they entered the preoperative preparation room and when they ended the postoperative waiting period for the rapid frozen section procedure were assessed using the State Anxiety Inventory (S-AI) questionnaire, and their pain levels at the end of the postoperative waiting period were assessed using the short-form McGill Pain Questionnaire. The patients enrolled were divided into 3 groups according to the preoperative waiting time: <2 hours (T1 group), 2 to 4 hours (T2 group), and >4 hours (T3 group); there were 150 patients in each group, and the anxiety and pain levels were compared between the groups. RESULTS At the time of entering the preoperative preparation room, patients' S-AI score T1 = T2 ( P > 0.05), both T1 and T2 < T3 ( P < 0.05); however, at the time of the postoperative waiting period, patients' S-AI score was T1 < T2 < T3 ( P < 0.05), and the postoperative waiting period patients' short-form McGill Pain Questionnaire scores were T1 = T2 < T3 ( P < 0.05). CONCLUSIONS The perioperative anxiety and pain levels of patients undergoing outpatient breast surgery increased with the prolongation of preoperative waiting time; 4 hours was the critical time point for change, after which the anxiety and pain levels of patients increased significantly.
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Affiliation(s)
- Bei Wu
- From the Departments of Operating Room
| | | | | | - Zhen-Hua Zhong
- Breast Center, The Women and Children's Hospital of Ningbo, Ningbo, China
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Sander D, Bartsch T, Connolly F, Enzinger C, Fischer U, Nellessen N, Poppert H, Szabo K, Topka H. Guideline "Transient Global Amnesia (TGA)" of the German Society of Neurology (Deutsche Gesellschaft für Neurologie): S1-guideline. Neurol Res Pract 2023; 5:15. [PMID: 37076927 PMCID: PMC10116751 DOI: 10.1186/s42466-023-00240-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/21/2023] Open
Abstract
INTRODUCTION In 2022 the DGN (Deutsche Gesellschaft für Neurologie) published an updated Transient Global Amnesia (TGA) guideline. TGA is characterized by a sudden onset of retrograde and anterograde amnesia for a period of one to a maximum of 24 h (with an average of 6 to 8 h). The incidence is estimated between 3 and 8 per 100,000 population/year. TGA is a disorder that occurs predominantly between 50 and 70 years. RECOMMENDATIONS The diagnosis of TGA should be made clinically. In case of an atypical clinical presentation or suspicion of a possible differential diagnosis, further diagnostics should be performed immediately. The detection of typical unilateral or bilateral punctate DWI/T2 lesions in the hippocampus (especially the CA1 region) in a proportion of patients proves TGA. The sensitivity of MRI is considered higher when performed between 24 and 72 h after onset. If additional DWI changes occur outside the hippocampus, a vascular etiology should be considered, and prompt sonographic and cardiac diagnostics should be performed EEG may help to differentiate TGA from rare amnestic epileptic attacks, especially in recurrent amnestic attacks. TGA in patients < 50 years of age is a rarity, therefore it is mandatory to rapidly search for other causes in particular in younger patients. The cause of TGA is still unknown. Numerous findings in recent years point to a multifactorial genesis. Because the pathomechanism of TGA is not yet clearly known, no evidence-based therapeutic or prophylactic recommendations can be made. CONCLUSIONS There is no evidence for chronic sequelae of TGA with respect to cerebral ischemia, chronic memory impairment, or the onset of dementia-related syndromes.
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Affiliation(s)
- Dirk Sander
- Klinik für Neurologie, Neurologische Frührehabilitation und Weiterführende Rehabilitation, Benedictus Krankenhaus Tutzing und Feldafing, Bahnhofstraße 5, 82327, Tutzing, Germany.
| | - Thorsten Bartsch
- Neurologische Universitätsklinik Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Florian Connolly
- Praxis für Neurologie, Hauptstraße 31-35, 14776, Brandenburg an der Havel, Germany
| | - Christian Enzinger
- Neurologische Universitätsklinik, Medizinische Universität Graz, Graz, Austria
| | - Urs Fischer
- Neurologische Universitätsklinik, Universitätsspital Basel, Basel, Switzerland
| | - Nils Nellessen
- Klinik für Neurologie und Neurophysiologie, Helios Universitätsklinikum Wuppertal, Universität Witten-Herdecke, Wuppertal, Germany
| | - Holger Poppert
- Neurologische Klinik, Helios Klinikum München West, Munich, Germany
| | - Kristina Szabo
- Neurologische Klinik, Universitätsmedizin Mannheim, Medizinische Fakultät der Universität Heidelberg, Mannheim, Germany
| | - Helge Topka
- Klinik für Neurologie, Neurophysiologie, Kognitive Neurologie und Stroke Unit, München Klinik Bogenhausen, Munich, Germany
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Segobin S, Renault C, Viader F, Eustache F, Pitel AL, Quinette P. Disruption in normal correlational patterns of metabolic networks in the limbic circuit during transient global amnesia. Brain Commun 2023; 5:fcad082. [PMID: 37101832 PMCID: PMC10123398 DOI: 10.1093/braincomms/fcad082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/06/2022] [Accepted: 03/17/2023] [Indexed: 04/28/2023] Open
Abstract
Transient global amnesia is characterized by the sudden apparition of severe episodic amnesia, mainly anterograde, associated with emotional changes. Even though the symptoms are stereotyped, cerebral mechanism underlying transient global amnesia remains unexplained and previous studies using positron emission tomography do not show any clear results or consensus on cerebral regions impacted during transient global amnesia. This study included a group of 10 transient global amnesic patients who underwent 18F-fluorodeoxyglucose positron emission tomography during the acute or recovery phase of the episode and 10 paired healthy controls. Episodic memory was evaluated with the encoding-storage-retrieval paradigm and a story recall test of the Wechsler's memory scale and anxiety was assessed with the Spielberger scale. We used statistical parametric mapping to identify modifications of whole-brain metabolism. Regarding hypometabolism, there was no brain region systematically affected in all transient global amnesic patients and the comparison between amnesic patients and controls did not show any significant differences. To better understand the specific implication of the limbic circuit in the pathophysiology of transient global amnesia, we then conducted a correlational analysis that included regions of this network. Our findings showed that in healthy controls, regions of the limbic circuit seem to operate in a synchronized way with all regions being highly correlated to each other. On the opposite, in transient global amnesic patients, we observed a clear disruption of this normal correlational patterns between regions with the medial temporal lobe (the hippocampus, parahippocampal gyrus and amygdala) included in one cluster and the orbitofrontal cortex, anterior and posterior cingulate gyrus and thalamus gathered in the other one. Given the individual variability in the time course of transient global amnesia, the direct comparison between a group of patients and controls does not seem to favour the identification of subtle and transient alterations in regional metabolism. The involvement of an extended network, such as the limbic circuit, seems more likely to explain the symptoms of patients. Indeed, the synchronization of regions within the limbic circuit seems to be altered during transient global amnesia, which could explain the amnesia and anxiety observed in transient global amnesic patients. The present study thus deepens our understanding of the mechanisms underlying not only amnesia but also the emotional component of transient global amnesia by considering it as a disruption in the normal correlational patterns within the limbic circuit.
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Affiliation(s)
| | | | - Fausto Viader
- Normandie University, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, 14032, Caen, Normandie, France
| | - Francis Eustache
- Normandie University, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, 14032, Caen, Normandie, France
| | | | - Peggy Quinette
- Correspondence to: Peggy Quinette Unité de recherche Inserm-EPHE-Unicaen U1077 Neuropsychologie et Imagerie de la Mémoire Humaine Pôle des Formations et de Recherches en Santé 2, rue des Rochambelles, F-14032 Caen Cedex CS, France E-mail:
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Hippocampal infarction: redefining transient global amnesia. Neurol Sci 2022; 43:4281-4286. [DOI: 10.1007/s10072-022-05980-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 02/21/2022] [Indexed: 10/18/2022]
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Wittayer M, Hoyer C, Roßmanith C, Platten M, Gass A, Szabo K. Hippocampal subfield involvement in patients with transient global amnesia. J Neuroimaging 2022; 32:264-267. [PMID: 35106877 DOI: 10.1111/jon.12973] [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: 12/21/2021] [Revised: 01/12/2022] [Accepted: 01/12/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE Transient global amnesia (TGA) is a rare neurological disorder causing a transient disturbance of episodic long-term memory. Its etiology remains yet to be identified; the only consistently reported findings in patients with TGA are small hyperintense lesions in the hippocampus on diffusion-weighted magnetic resonance imaging (DWI). The aim of this study was to define whether these lesions are subfield specific, as suggested previously. METHODS High-resolution multiplanar reformation T1 and DWI of the hippocampus were acquired in 25 patients after TGA with a total of 43 hippocampal lesions. Hippocampal subfields were determined using the FreeSurfer software and the location of the DWI lesions was transformed to the T1 images after data co-registration. Additionally, hippocampal subfield volumes in each patient were calculated and compared with that of 20 healthy controls. RESULTS Hippocampal lesions were most frequently detected in the cornu ammonis area 1 (CA1) subfield (30.2%), the hippocampal tail (28.0%), and the subiculum (21.0%); however, lesions were also found in other subfields. There was no significant difference between patients and controls concerning the volumes of the hippocampal subfields. CONCLUSIONS Contrasting previous assumptions, we found DWI hyperintense lesions not to be restricted to the CA1 subfield. The visualization of focal hippocampal lesions on diffusion imaging located to several different hippocampal subfields suggests a potential pathophysiology of TGA independent of microstructural hippocampal anatomy and subfield-specific vulnerability.
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Affiliation(s)
- Matthias Wittayer
- Department of Neurology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Mannheim Center for Translational Neurosciences (MCTN), Heidelberg University, Mannheim, Germany
| | - Carolin Hoyer
- Department of Neurology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Mannheim Center for Translational Neurosciences (MCTN), Heidelberg University, Mannheim, Germany
| | - Christina Roßmanith
- Department of Neurology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Mannheim Center for Translational Neurosciences (MCTN), Heidelberg University, Mannheim, Germany
| | - Michael Platten
- Department of Neurology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Mannheim Center for Translational Neurosciences (MCTN), Heidelberg University, Mannheim, Germany
| | - Achim Gass
- Department of Neurology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Mannheim Center for Translational Neurosciences (MCTN), Heidelberg University, Mannheim, Germany
| | - Kristina Szabo
- Department of Neurology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Mannheim Center for Translational Neurosciences (MCTN), Heidelberg University, Mannheim, Germany
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Ramjohn NS, Kallan A, Qureshi MA. A Case of Transient Global Amnesia: A Rare Diagnosis. Cureus 2022; 14:e21637. [PMID: 35233315 PMCID: PMC8881234 DOI: 10.7759/cureus.21637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2022] [Indexed: 11/05/2022] Open
Abstract
Transient global amnesia (TGA) is a syndrome characterized by a loss of anterograde memory with a less prominent loss in retrograde episodic memory that resolves within 24 hours or less. In this report, we present a rare case of a 62-year-old male who presented to the emergency department with sudden onset confusion and memory loss. Prior to this, the patient had no significant medical or psychiatric history. Magnetic resonance imaging (MRI) and computerized tomography (CT) showed a normal presentation, and a neurology consultation ruled out any organic brain abnormalities. After ruling out all other potential causes, diagnosis of transient global amnesia was made. We present this case highlighting the importance of ruling out other acutely morbid conditions when addressing TGA, guidance on timing of imaging, as well as offering insight on other etiologies of this condition.
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Hoyer C, Ebert A, Sandikci V, Platten M, Szabo K. Sex-related differences in stressful events precipitating transient global amnesia - A retrospective observational study. J Neurol Sci 2021; 425:117464. [PMID: 33892277 DOI: 10.1016/j.jns.2021.117464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/06/2021] [Accepted: 04/15/2021] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Physically or emotionally charged events have consistently been reported as precipitating an episode of transient global amnesia (TGA). In conjunction with evidence of hippocampal involvement from neuroimaging, this has promoted the hypothesis that TGA is a stress-related disorder. METHODS In this retrospective observational study, medical records of 389 patients with TGA were analysed regarding documented precipitating events, which were classified according to previously suggested criteria. Moreover, comorbidities and results of magnetic resonance imaging were collected. FINDINGS In our cohort of TGA patients, 231 were female (59.4%). A precipitating factor was identified in 266 patients (68.4%). Of these, 136 patients (51.1%) reported physical triggers, the most common being physical exertion (64.0%). Another 122 patients (45.9%) presented with an emotional trigger, most frequently classified as an interpersonal conflict (42.7%). In 8 cases (2.1%), TGA was preceded by a medical procedure. Emotional triggers were more often experienced by women (37.2% vs 22.8%, p = 0.003), while physical stressors were more often present in men (30.7% vs 41.1%, p = 0.035). Women had a significantly higher number of hippocampal MRI lesions than men (mean 1.13 vs 0.92; p = 0.042). CONCLUSION Our data suggest a female predominance in TGA occurrence and a sex-related difference in susceptibility to certain triggering events in TGA patients. In light of recent research on sex-specific differences in vulnerability to stress, these findings support the hypothesis that this might be a significant contributing factor in the pathogenesis of TGA.
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Affiliation(s)
- Carolin Hoyer
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), Heidelberg University, Mannheim, Germany.
| | - Anne Ebert
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), Heidelberg University, Mannheim, Germany
| | - Vesile Sandikci
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), Heidelberg University, Mannheim, Germany
| | - Michael Platten
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), Heidelberg University, Mannheim, Germany
| | - Kristina Szabo
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), Heidelberg University, Mannheim, Germany
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Becquet C, Viader F, Eustache F, Quinette P. Self-awareness in Transient Global Amnesia: distinguishing the effects of transient memory disorder vs. pre-existing vulnerability factors. Neurocase 2021; 27:196-204. [PMID: 33856957 DOI: 10.1080/13554794.2021.1912359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Numerous evidences suggest the existence of relationships between the impairment of episodic memory, acute stress exposure and variations in self-awareness (SA). Here, we examined 27 patients presenting transient global amnesia (TGA), a clinical condition which combines episodic amnesia and high anxiety, thanks to state and trait questionnaires of SA. We observed variation of SA depending on the stage of TGA (acute, recovery and follow-up). We also found preexisting differences in patient's awareness of their own image when the precipitating event was physical, encouraging us to give more consideration to the social determinants of stress in physiological cascade of TGA.
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Affiliation(s)
- Céline Becquet
- Normandie Univ, UNICAEN, PSL Université Paris, EPHE, INSERM, U1077, CHU de Caen, Centre Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000, Caen, France
| | - Fausto Viader
- Normandie Univ, UNICAEN, PSL Université Paris, EPHE, INSERM, U1077, CHU de Caen, Centre Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000, Caen, France
| | - Francis Eustache
- Normandie Univ, UNICAEN, PSL Université Paris, EPHE, INSERM, U1077, CHU de Caen, Centre Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000, Caen, France
| | - Peggy Quinette
- Normandie Univ, UNICAEN, PSL Université Paris, EPHE, INSERM, U1077, CHU de Caen, Centre Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000, Caen, France
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Grabovskyi SS, Panchuk RR, Skorokhyd NR, Stoika RS. Male and female rats differ in homeostatic shifts during pre-slaughter fear stress. UKRAINIAN BIOCHEMICAL JOURNAL 2021. [DOI: 10.15407/ubj93.01.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Werner R, Woehrle JC. Prevalence of Mimics and Severe Comorbidity in Patients with Clinically Suspected Transient Global Amnesia. Cerebrovasc Dis 2021; 50:171-177. [PMID: 33412553 DOI: 10.1159/000512602] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/21/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Transient global amnesia (TGA) is a syndrome featuring acute anterograde amnesia as the most striking clinical symptom. Its etiology is still a matter of debate. Most neurological guidelines allow the diagnosis on the basis of clinical criteria only; a more extensive evaluation is recommended only for patients with "red flags" like severe headache, nausea or vomiting, or metabolic abnormalities. The aim of our study was to assess the frequency of a severe underlying disease or alternative diagnoses (mimics) in patients fulfilling the clinical criteria. METHODS We evaluated the medical records and the imaging data of an unselected consecutive cohort of patients with suspected TGA over a 7-year period. All patients were hospitalized and received a neurological workup including brain imaging, color-coded duplex sonography of the brain supplying arteries, electroencephalography, and laboratory studies of blood and (in selected cases) cerebrospinal fluid. RESULTS 163 patients with 166 episodes of suspected TGA were hospitalized (3 patients twice). After the workup, the diagnosis of TGA was confirmed in 148/166 (89.2%) episodes ("simple TGA"). Eighteen patients (10.8%) either had an alternative diagnosis or a severe comorbidity that was assumed to have had an impact on the occurrence of the amnestic episode ("complicated TGA/mimic"). The most important differential diagnosis was stroke (11 patients, 6.6% of all TGA suspects and 61.1% of the complicated TGA/mimic group). Other mimics were transient epileptic amnesia (2 patients) and steroid-induced delirium (1 patient). Important comorbidities that had not been obvious at the time of presentation were severe sleep apnea (2 patients), triptan overuse (1 patient), and an involuntary amlodipine intoxication during TGA. CONCLUSION As approximately every tenth patient with suspected TGA either had an alternative diagnosis or a severe comorbidity, which had not been obvious at the time of admission, we consider in-patient treatment of all suspected TGA cases as appropriate, preferably in the setting of a stroke unit, as ischemic stroke was the by far most important diagnosis mimicking TGA.
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Affiliation(s)
- Ralph Werner
- Department of Neurology/Stroke Unit, Katholisches Klinikum Koblenz-Montabaur, Koblenz, Germany,
| | - Johannes C Woehrle
- Department of Neurology/Stroke Unit, Katholisches Klinikum Koblenz-Montabaur, Koblenz, Germany
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Ding X, Peng D. Transient Global Amnesia: An Electrophysiological Disorder Based on Cortical Spreading Depression-Transient Global Amnesia Model. Front Hum Neurosci 2020; 14:602496. [PMID: 33363460 PMCID: PMC7753037 DOI: 10.3389/fnhum.2020.602496] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/17/2020] [Indexed: 01/09/2023] Open
Abstract
Transient global amnesia (TGA) is a benign memory disorder with etiologies that have been debated for a long time. The prevalence of stressful events before a TGA attack makes it hard to overlook these precipitating factors, given that stress has the potential to organically effect the brain. Cortical spreading depression (CSD) was proposed as a possible cause decades ago. Being a regional phenomenon, CSD seems to affect every aspect of the micro-mechanism in maintaining the homeostasis of the central nervous system (CNS). Corresponding evidence regarding hemodynamic and morphological changes from TGA and CSD have been accumulated separately, but the resemblance between the two has not been systematically explored so far, which is surprising especially considering that CSD had been confirmed to cause secondary damage in the human brain. Thus, by deeply delving into the anatomic and electrophysiological properties of the CNS, the CSD-TGA model may render insights into the basic pathophysiology behind the façade of the enigmatic clinical presentation.
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Affiliation(s)
- Xuejiao Ding
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Dantao Peng
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
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Govoni V, Cesnik E, Ferri C, Fallica E. The distribution of the transient global amnesia in the province of Ferrara, Italy, a clue to the pathogenesis? Neurol Sci 2020; 42:1821-1826. [DOI: 10.1007/s10072-020-04696-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/28/2020] [Indexed: 11/29/2022]
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15
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Serum cortisol levels in patients with a transient global amnesia. Rev Neurol (Paris) 2020; 176:285-288. [DOI: 10.1016/j.neurol.2019.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 08/15/2019] [Accepted: 08/27/2019] [Indexed: 01/08/2023]
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16
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Eisele P, Baumann S, Noor L, El-Battrawy I, Ebert A, Gass A, Akin I, Kittel M, Platten M, Szabo K. Interaction between the heart and the brain in transient global amnesia. J Neurol 2019; 266:3048-3057. [DOI: 10.1007/s00415-019-09529-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 09/03/2019] [Accepted: 09/04/2019] [Indexed: 10/26/2022]
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17
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Kamm K, Schöberl F, Grabova D, Straube A, Zwergal A. RCVS and TGA: a common pathophysiology? J Neurol 2019; 266:2872-2874. [PMID: 31385018 DOI: 10.1007/s00415-019-09495-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/31/2019] [Accepted: 07/31/2019] [Indexed: 01/01/2023]
Affiliation(s)
- Katharina Kamm
- Department of Neurology, Ludwig-Maximilians-University, Munich, Germany
| | - Florian Schöberl
- Department of Neurology, Ludwig-Maximilians-University, Munich, Germany.,Department of Neurology and German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Denis Grabova
- Department of Neurology, Ludwig-Maximilians-University, Munich, Germany.,Department of Neurology and German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Andreas Straube
- Department of Neurology, Ludwig-Maximilians-University, Munich, Germany.,Department of Neurology and German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Andreas Zwergal
- Department of Neurology, Ludwig-Maximilians-University, Munich, Germany. .,Department of Neurology and German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany.
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Simultaneous transient global amnesia and Takotsubo syndrome after death of a relative: a case report. J Med Case Rep 2019; 13:22. [PMID: 30678717 PMCID: PMC6346500 DOI: 10.1186/s13256-018-1928-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 11/15/2018] [Indexed: 01/21/2023] Open
Abstract
Introduction Simultaneous occurrence of transient global amnesia and Takotsubo syndrome has been only rarely reported. Here we report another patient with a transient global amnesia and concomitant Takotsubo syndrome. Case presentation Our patient is a 64-year-old white man with a previous history of myocarditis from borreliosis who developed sudden-onset confusional state with perseverations and repetition of the same questions during a funeral for his brother-in-law. Upon neurological work-up and after spontaneous resolution of most of the neurological deficits, transient global amnesia was diagnosed. Blood tests revealed moderate renal insufficiency, elevated troponin-T, and elevated N-terminal prohormone of brain natriuretic peptide. Electrocardiography showed left anterior hemiblock and negative T-waves in V2–V6. Upon transthoracic echocardiography the apical type of a Takotsubo syndrome was suspected. Since coronary angiography was normal and electrocardiography and echocardiographic abnormalities resolved under candesartan, bisoprolol, acetyl-salicylic acid, and atorvastatin within a few days after onset, Takotsubo syndrome was diagnosed. Conclusions Since Takotsubo syndrome may be associated with transient global amnesia a causal relation may exist. A possible trigger for both conditions could be severe emotional stress from the loss of a close relative. A possible common pathomechanism could be overstimulation of adrenergic receptors in the myocardium, the cerebrum, or the coronary or cerebral arteries. Whether pre-existing myocardial compromise promotes the development of Takotsubo syndrome requires further investigations.
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