Simultaneous transient global amnesia and right MCA stroke after Valsalva manoeuvre

Intranasal etripamil for rapid treatment of paroxysmal supraventricular tachycardia

Paroxysmal supraventricular tachycardia (PSVT) is a common arrhythmia that, although usually benign, can occur unpredictably, cause disabling symptoms and significantly impair quality of life. If spontaneous resolution does not occur, the only current self-treatment is for the patient to attempt vagal maneuvers, however, these are frequently unsuccessful. Hospital attendance is then required for intravenous therapy. Etripamil, an intranasal calcium channel blocker similar to verapamil, may be able to fill this therapeutic gap, allowing rapid self-treatment of PSVT at home. This narrative review discusses the latest evidence for etripamil and its potential role in future clinical practice.

Transient Global Amnesia Masquerading as Transient Ischemic Attack

Transient global amnesia (TGA) is a rare self-limited syndrome characterized primarily by anterograde amnesia. It shares multiple characteristics with a transient ischemic attack and ischemic stroke, which carry a more ominous outlook. There is a debate with respect to what is sufficient for ruling out more serious pathologies. Additionally, there is data that challenge the historical view that TGA is a benign condition requiring no long-term management. Here, we present the case of a 70-year-old female who was admitted to a free-standing emergency room with confusion, memory loss, and hypertensive crisis that was diagnosed as TGA. The patient was evaluated by a neurologist and transferred to the hospital. The patient was discharged after more serious pathologies were excluded after an extensive workup. This scenario showcases how physicians have to balance the risk of serious diseases with the need for further testing. Future research should focus on how to accurately identify or rule out serious diseases leading to a reduction in adverse events and patient costs. It is also not clear if TGA is truly benign or has an association with stroke.

Acute neurological disease as a trigger or co-occurrence of transient global amnesia: a case series and systematic review

BACKGROUND

Transient global amnesia (TGA) represents a benign neurological syndrome of unknown pathophysiology, often accompanied by vanishing hippocampal punctate lesions on diffusion-weighted imaging (hippocampal punctate diffusion lesion, HPDL). The recent literature suggests that TGA may be triggered by acute neurological conditions.

OBJECTIVE

To study patients with TGA triggered by an acute neurological disease.

METHODS

We retrospectively reviewed patients from two neurology centres with TGA (with or without HPDL) in whom an acute neurological condition could be identified as trigger. We also performed a systematic review of the literature of this situation using predefined search terms.

RESULTS

We identified 38 patients (median age 62 years, 55.3% female): 6 from our centres and 32 from the literature. Acute neurovascular diseases that preceded or were associated with TGA included ischemic and haemorrhagic strokes, convexity subarachnoid haemorrhage, and reversible cerebral vasoconstriction syndrome. As non-vascular acute neurological diseases, we identified migraine and peripheral-origin vertigo. The clinical manifestation of the neurological trigger showed a variable temporal relation with TGA onset; in some cases preceding and in others co-occurring with TGA manifestation. In some cases, presumed neurological triggers were asymptomatic and diagnosed from the neuroimaging done for the TGA.

CONCLUSIONS

Acute vascular and non-vascular neurological events may trigger TGAs or may occur simultaneously. In the first case, such an acute neurological disease may activate direct pathways within the nervous systems leading to TGA, or alternatively elicit a bodily sympathetic overactivity cascade. In the second case, both neurological events may be the result of a common external stressor.

Imaging Findings Related to the Valsalva Maneuver in Head and Neck Radiology

Forced exhalation against a closed glottis, known as the Valsalva maneuver, is an important clinical diagnostic and therapeutic tool due to its physiologic effects. Several unique conditions and anatomic changes can occur with repetitive or acute changes in pressure from the Valsalva maneuver. We will discuss and review various pertinent head and neck imaging cases with findings resulting from induced pressure gradients, including the Valsalva maneuver. Additionally, we will demonstrate the diagnostic utility of the Valsalva maneuver in head and neck radiology.