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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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Golenia A, Ferens A, Kolasa A, Ignatiuk A, Kostera-Pruszczyk A. Transient global amnesia - hippocampal lesions in magnetic resonance imaging. J Stroke Cerebrovasc Dis 2023; 32:106951. [PMID: 36565520 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106951] [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: 10/19/2022] [Revised: 12/12/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Transient global amnesia is a benign syndrome characterized by a sudden onset loss of anterograde amnesia with full recovery. Magnetic resonance of the brain including diffusion-weighted imaging of patients with transient global amnesia revealed the presence of punctate hyperintense signal abnormalities in the hippocampus. OBJECTIVE Analysis of the presence of hippocampal lesions in brain magnetic resonance imaging in patients with transient global amnesia and the possible influence of additional factors on their appearance. METHODS In this retrospective, an observational study we assessed brain magnetic resonance imaging in 38 consecutive patients with transient global amnesia. The incidence of brain magnetic resonance imaging lesions was analyzed for the coexisting cardiovascular risk factors and precipitating events. RESULTS Hippocampal brain magnetic resonance imaging lesions were detected in 47% of patients with transient global amnesia. Of those, 65% had unilateral lesions, 82% were left-sided, and 28% were right-sided. Most lesions were located in the CA1 subfield. The incidence of hypertension in patients with transient global amnesia was higher than in the general population. Stress and exercise preceded the onset of transient global amnesia only in 13% and 16% of patients, respectively. There was no higher incidence of migraine in transient global amnesia patients (13%). CONCLUSIONS We found that nearly 50% of patients with transient global amnesia had hyperintense hippocampal brain magnetic resonance imaging lesions. In addition to hypertension, individuals with transient global amnesia had similar cardiovascular risk factors as the general population. We did not identify any precipitating events prior to the onset of transient global amnesia.
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Affiliation(s)
| | - Antoni Ferens
- Department of Neurology, Medical University of Warsaw, Poland.
| | - Anna Kolasa
- Department of Radiology, Medical University of Warsaw, Poland.
| | - Aleksandra Ignatiuk
- Department of Neurology, University Clinical Center, Medical University of Warsaw, Poland.
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Rogalewski A, Beyer A, Friedrich A, Zuhorn F, Klingebiel R, Woermann FG, Oertelt-Prigione S, Schäbitz WR. Transient Global Amnesia (TGA): Sex-Specific Differences in Blood Pressure and Cerebral Microangiopathy in Patients with TGA. J Clin Med 2022; 11:jcm11195803. [PMID: 36233669 PMCID: PMC9571788 DOI: 10.3390/jcm11195803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/09/2022] [Accepted: 09/27/2022] [Indexed: 11/16/2022] Open
Abstract
Transient global amnesia (TGA) is defined by an acute memory disturbance of unclear aetiology for a period of less than 24 h. Observed psychological, neuroanatomical and hormonal differences between the sexes in episodic memory suggest sex-specific differences in memory disorders such as TGA. The aim of this study was to determine sex-specific differences in cardiovascular risk profiles, recurrences and magnetic resonance imaging (MRI). In total, 372 hospitalised TGA patients between 01/2011 and 10/2021 were retrospectively analysed. Comparisons were made between female and male TGA patients and compared to 216 patients with acute stroke. In our sample, women were overrepresented (61.8%), especially compared to the general population in the 65−74 age category (χ2 = 10.6, p < 0.02). On admission, female TGA patients had significantly higher systolic blood pressure values and a higher degree of cerebral microangiopathy compared to male TGA patients, whereas acute stroke patients did not. No sex-specific differences were observed with respect to recurrences or hippocampal DWI lesions. Our data demonstrate sex-specific differences in TGA. The higher blood pressure on admission and different degree of cerebral microangiopathy in female TGA patients supports the theory of blood pressure dysregulation as a disease trigger. Distinct precipitating events in female and male patients could lead to differences in the severity and duration of blood pressure abnormalities, possibly explaining the higher incidence in female patients.
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Affiliation(s)
- Andreas Rogalewski
- Department of Neurology, Evangelisches Klinikum Bethel, University Hospital OWL, University Bielefeld, 33611 Bielefeld, Germany
- Correspondence: ; Tel.: +49-521-772-78301; Fax: +49-521-772-78302
| | - Anne Beyer
- Department of Neurology, Evangelisches Klinikum Bethel, University Hospital OWL, University Bielefeld, 33611 Bielefeld, Germany
| | - Anja Friedrich
- Department of Psychology, Bielefeld University, 33615 Bielefeld, Germany
| | - Frédéric Zuhorn
- Department of Neurology, Evangelisches Klinikum Bethel, University Hospital OWL, University Bielefeld, 33611 Bielefeld, Germany
| | - Randolf Klingebiel
- Department of Neuroradiology, Evangelisches Klinikum Bethel EvKB, University Hospital OWL, University Bielefeld, 33617 Bielefeld, Germany
| | - Friedrich G. Woermann
- Department of Epileptology (Krankenhaus Mara), University Hospital OWL, University Bielefeld, 33617 Bielefeld, Germany
| | | | - Wolf-Rüdiger Schäbitz
- Department of Neurology, Evangelisches Klinikum Bethel, University Hospital OWL, University Bielefeld, 33611 Bielefeld, Germany
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Conventional cardiovascular risk factors in Transient Global Amnesia: Systematic review and proposition of a novel hypothesis. Front Neuroendocrinol 2021; 61:100909. [PMID: 33539928 DOI: 10.1016/j.yfrne.2021.100909] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/07/2021] [Accepted: 01/27/2021] [Indexed: 12/15/2022]
Abstract
Transient Global Amnesia (TGA) is an enigmatic amnestic syndrome. We conducted a systematic review to investigate the relationship between the conventional cardiovascular risk factors and TGA. MEDLINE, CENTRAL, EMBASE and PsycINFO were comprehensively searched and 23 controlled observational studies were retrieved. The prevalence of hypertension, diabetes mellitus, dyslipidemia and smoking was lower among patients with TGA compared to Transient Ischemic Attack. Regarding the comparison of TGA with healthy individuals, there was strong evidence suggesting a protective effect of diabetes mellitus on TGA and weaker evidence for a protective effect of smoking. Hypertension was associated with TGA only in more severe stages, while dyslipidemia was not related. In view of these findings, a novel pathophysiological hypothesis is proposed, in which the functional interactions of Angiotensin-II type-1 and N-methyl-D-aspartate receptors are of pivotal importance. The whole body of clinical evidence (nature of precipitating events, associations with migraine, gender-based association patterns) was integrated.
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Liampas I, Raptopoulou M, Mpourlios S, Siokas V, Tsouris Z, Aloizou AM, Dastamani M, Brotis A, Bogdanos D, Xiromerisiou G, Dardiotis E. Factors associated with recurrent transient global amnesia: systematic review and pathophysiological insights. Rev Neurosci 2021; 32:751-765. [PMID: 33675214 DOI: 10.1515/revneuro-2021-0009] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 02/15/2021] [Indexed: 12/20/2022]
Abstract
The examination of the risk factors that affect the recurrence of transient global amnesia (TGA) may shed light on the pathophysiological substrate of the disease. A systematic review was performed to identify the factors associated with the recurrence of TGA. MEDLINE, EMBASE, CENTRAL and PsycINFO were meticulously searched. Observational controlled studies involving patients with single (s-TGA) and recurrent TGA (r-TGA) according to Hodges and Warlow's criteria were retrieved. Differences in the demographic characteristics, personal and family medical history, previous exposure to precipitating events and laboratory findings were examined. Retrieved evidence was assessed in the context of the individual article validity, based on the numerical power and methodological quality of each study. Nine cohort studies with retrospective, prospective or mixed design were retrieved. In total, 1989 patients with TGA were included, 269 of whom suffered from r-TGA (13.5%). R-TGA presented an earlier age of onset. Evidence was suggestive of a relationship between recurrence and a family or personal history of migraine, as well as a personal history of depression. There was weaker evidence that associated recurrence with a positive family history of dementia, a personal history of head injury and hippocampal lesions in diffusion-weighted MRI. On the other hand, no connection was found between recurrence and electroencephalographic abnormalities, impaired jugular venous drainage, cardiovascular risk factors, atrial fibrillation, previous cerebrovascular events, exposure to precipitating events, a positive family history of TGA and hypothyroidism. Important pathophysiological insights that arised from these findings were discussed.
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Affiliation(s)
- Ioannis Liampas
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Mezourlo Hill, 41100Larissa, Greece
| | - Maria Raptopoulou
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Mezourlo Hill, 41100Larissa, Greece.,First Department of Internal Medicine, General Hospital of Trikala, Karditsis 56, 42100Trikala, Greece
| | - Stefanos Mpourlios
- School of Medicine, University of Thessaly, Mezourlo Hill, 41100Larissa, Greece
| | - Vasileios Siokas
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Mezourlo Hill, 41100Larissa, Greece
| | - Zisis Tsouris
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Mezourlo Hill, 41100Larissa, Greece
| | - Athina-Maria Aloizou
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Mezourlo Hill, 41100Larissa, Greece
| | - Metaxia Dastamani
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Mezourlo Hill, 41100Larissa, Greece
| | - Alexandros Brotis
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Mezourlo Hill, 41100Larissa, Greece
| | - Dimitrios Bogdanos
- Department of Rheumatology and clinical Immunology, University Hospital of Larissa, School of Medicine, University of Thessaly, Mezourlo Hill, 41100Larissa, Greece
| | - Georgia Xiromerisiou
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Mezourlo Hill, 41100Larissa, Greece
| | - Efthimios Dardiotis
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Mezourlo Hill, 41100Larissa, Greece
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Migraine in transient global amnesia: a meta-analysis of observational studies. J Neurol 2021; 269:184-196. [PMID: 33388926 DOI: 10.1007/s00415-020-10363-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND PURPOSE: Although many studies have investigated the relationship between transient global amnesia (TGA) and migraine, to date, no meta-analysis has confirmed the existence and size of their association. METHODOLOGY Literature search involved MEDLINE, EMBASE, CENTRAL and PsycINFO. Observational controlled studies including TGA patients (Caplan, Hodges and Warlow) were retrieved. Quality evaluation was based on the Newcastle-Ottawa scale. The prevalence of migraine was compared in TGA patients vs. healthy controls (HC), as well as in TGA against TIA individuals. Data from case-control, cross-sectional and cohort studies were pooled separately. RESULTS Literature search yielded 1178 articles, 12 of which were included in the present meta-analysis. Results from case-control (ten), cohort (one) and cross-sectional (one) studies were compatible with an association between TGA and migraine. The nationwide inpatient cross-sectional study was of lesser value due to its inpatient orientation. The high-quality, population-based, retrospective cohort (158,301 participants per group) determined a higher relative-risk (RR) of TGA for migraine vs. non-migraine individuals [RR = 2.48, 95%confidence-interval (95% CI) = (1.32, 4.87)]. Sensitivity testing based on stricter diagnostic criteria strengthened the estimated association [RR = 3.84, 95% CI = (1.57, 9.38)]. Additionally, pooled data from eight case-control studies (700 TGA, 746 HC) yielded similar results [Odds-Ratio, OR = 2.51, 95% CI = (1.85, 3.41)], with the association mainly driven by the three high-quality studies, rather than the five articles of moderate quality. Finally, pooled findings from four case-control studies of moderate-quality revealed a higher prevalence of migraine among TGA compared to TIA patients [OR = 1.82, 95% CI = (1.22, 2.73)]. CONCLUSIONS A significant association between TGA and migraine was established. The underlying connecting mechanism remains undetermined, yet.
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Cassar MP, Balkhausen K. Transient global amnesia following transoesophageal echocardiography. BMJ Case Rep 2020; 13:13/4/e234751. [PMID: 32350056 DOI: 10.1136/bcr-2020-234751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Transient global amnesia (TGA) is characterised by the sudden onset of isolated anterograde amnesia, which resolves within 24 hours. Here, we discuss the case of a 63-year-old woman who underwent a transoesophageal echocardiogram (TOE) as part of her workup for pulmonary hypertension. She was well on the morning of the procedure, and following consent, underwent transoesophageal echocardiography without sedation. The procedure was uncomplicated with normal observations throughout, confirming a suspected secundum atrial septal defect. Immediately following oesophageal extubation, it was noted that the patient was disoriented. The physical neurological examination was unremarkable. Urgent MRI of the brain showed normal anatomy; a diagnosis of TGA was made. Within 10 hours of onset, the patient was back to her baseline. Isolated anterograde amnesia following transoesophageal echocardiography should raise the clinical suspicion of TGA. Prompt clinical examination and support from other specialties are paramount in making the right diagnosis.
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Affiliation(s)
- Mark Philip Cassar
- Department of Cardiology, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Katrin Balkhausen
- Department of Cardiology, Royal Berkshire NHS Foundation Trust, Reading, UK
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Alessandro L, Calandri IL, Suarez MF, Heredia ML, Chaves H, Allegri RF, Farez MF. Transient global amnesia: clinical features and prognostic factors suggesting recurrence. ARQUIVOS DE NEURO-PSIQUIATRIA 2019; 77:3-9. [PMID: 30758436 DOI: 10.1590/0004-282x20180157] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 10/17/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The risk of recurrence of new amnesia events in patients having previously experienced transient global amnesia (TGA) ranges between 2.9-23.8%. Our objective was to search for recurrence predictors in TGA patients. METHODS Retrospective analysis to identify recurrence predictors in a cohort of 203 TGA patients from a single center in Buenos Aires, Argentina, diagnosed between January 2011 and March 2017 Clinical features and complementary studies (laboratory results, jugular vein Doppler ultrasound and brain MRI) were analyzed. Comparison between patients with recurrent versus single episode TGA was performed, applying a multivariate logistic regression model. RESULTS Mean age at presentation was 65 years (20-84); 52% were female. Median time elapsed between symptom onset and ER visit was two hours, with the average episode duration lasting four hours. Mean follow-up was 22 months. Sixty-six percent of patients referred to an identifiable trigger. Jugular reflux was present in 66% of patients; and 22% showed images with hippocampus restriction on diffusion-weighted MRI. Eight percent of patients had TGA recurrence. Patients with recurrent TGA had a more frequent history of migraine than patients without recurrence (37.5% vs. 14%; p = 0.03). None of the other clinical characteristics and complementary studies were predictors of increased risk of recurrence. CONCLUSIONS Patients with migraine may have a higher risk of recurrent TGA. None of the other clinical characteristics evaluated allowed us to predict an increased risk of recurrence. Although the complementary studies allowed us to guide the diagnosis, they did not appear to have a significant impact on the prediction of recurrence risk.
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Affiliation(s)
- Lucas Alessandro
- Raúl Carrea Institute for Neurological Research (FLENI), Department of Neurology, Buenos Aires, Argentina
| | - Ismael L Calandri
- Raúl Carrea Institute for Neurological Research (FLENI), Department of Neurology, Buenos Aires, Argentina
| | | | - María L Heredia
- Raúl Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina
| | - Hernán Chaves
- Department of Diagnostic Imaging, Raúl Carrea Institute for Neurological Research (FLENI), Department of Neurology, Buenos Aires, Argentina
| | - Ricardo F Allegri
- Raúl Carrea Institute for Neurological Research (FLENI), Department of Neurology, Buenos Aires, Argentina
| | - Mauricio F Farez
- Center for Research on Neuroimmunological Diseases (CIEN), Raúl Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina
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Han K, Hu HH, Chao AC, Chang FC, Chung CP, Hsu HY, Sheng WY, Wu J. Transient Global Amnesia Linked to Impairment of Brain Venous Drainage: An Ultrasound Investigation. Front Neurol 2019; 10:67. [PMID: 30804883 PMCID: PMC6370701 DOI: 10.3389/fneur.2019.00067] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 01/17/2019] [Indexed: 11/17/2022] Open
Abstract
Background: Previous neuroimaging and ultrasound studies suggested that compression and stenosis of the internal jugular vein (IJV) in patients with transient global amnesia (TGA) may impair IJV drainage, while a patent IJV releases intracranial pressure caused by the Valsalva maneuver (VM). Methods: Seventy-nine TGA patients with complete ultrasound examination data during admission were recruited prospectively to evaluate IJV drainage, which included the time-averaged mean velocity, and the cross-sectional lumen area of the IJV at the vein's middle (J2) and distal (J3) segments and the cross-sectional area during a 10-s VM to test for any retrograde or anti-grade flow. Forty-five TGA patients and 45 age- and sex-matched control subjects underwent complete contrast-enhanced magnetic resonance (MR) venous studies, which included time-resolved imaging of contrast kinetics, contrast-enhanced axial T1-weighted MR imaging, and phase-contrast-based non-contrast enhanced magnetic resonance venography (MRV). Results: In those subjects with complete MRV studies, the flow volumes exhibited at both the J2 and J3 segments of the left IJV and left vertebral vein (VV) were significantly lower in the TGA patients than in the control subjects. Although there was no significant difference in the flow volume of right IJV, the total of bilateral IJV, and VV flow volumes was still significantly lower in the TGA patients. As compared with the control subjects, the TGA patients exhibited significantly higher prevalence of completely blocked right IJV drainage at the J3 segment during the VM, but non-significantly higher for the left IJV at the J3 segment and for the right IJV at the J2 segment. Conclusion: Our results confirmed that the total venous flow decreases in the IJVs and VVs of the patients with TGA. This is consistent with the findings of previous MR imaging studies that have reported about compression and stenosis of the draining veins. We also found that IJV drainage is relatively compromised during the VM in the patients with TGA.
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Affiliation(s)
- Ke Han
- Department of Neurology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Han-Hwa Hu
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Cerebrovascular Treatment and Research Center, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Neurology, Taipei Medical University-Shaung Ho Hospital, Taipei, Taiwan
| | - A-Ching Chao
- Department of Neurology, College of Medicine, Kaohsiung Medical University and Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Feng-Chi Chang
- Department of Radiology, Taipei Veterans General Hospital and National Yang Ming University, Taipei, Taiwan
| | - Chih-Ping Chung
- Department of Neurology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
| | - Hung-Yi Hsu
- Department of Neurology, Tungs' Taichung Metro Harbor Hospital, Taichung, Taiwan
| | - Wen-Yung Sheng
- Department of Neurology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
| | - Jiang Wu
- Department of Neurology, First Hospital of Jilin University, Changchun, China
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Maetani Y, Nakamori M, Watanabe T, Matsushima H, Imamura E, Wakabayashi S. Subarachnoid hemorrhage after transient global amnesia caused by cerebral venous congestion: case report. BMC Neurol 2018; 18:36. [PMID: 29625555 PMCID: PMC5889575 DOI: 10.1186/s12883-018-1042-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 03/27/2018] [Indexed: 11/10/2022] Open
Abstract
Background Transient global amnesia is reported to be caused by cerebral venous congestion. Internal jugular venous flow reversal in particular with the Valsalva maneuver leads to cerebral venous congestion. In addition, Valsalva maneuver can also induce subarachnoid hemorrhage. Transient global amnesia and subarachnoid hemorrhage might have common a pathophysiology in cerebral venous congestion. Case presentation We report here the case of a 57-year-old woman who twice experienced convexal subarachnoid hemorrhage just after straining at stool following an episode of transient global amnesia. Digital subtraction angiography showed left temporal congestion. Left jugular vein ultrasonography revealed reflux with the Valsalva maneuver only in acute phase, indicating transient cerebral venous congestion. Conclusions Subarachnoid hemorrhage followed by transient global amnesia indicates a common factor between them. Transient venous congestion is discussed in order to explain this rare phenomenon. Electronic supplementary material The online version of this article (10.1186/s12883-018-1042-3) contains supplementary material, which is available to authorized users.
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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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Himeno T, Kuriyama M, Takemaru M, Kanaya Y, Shiga Y, Takeshima S, Takamatsu K, Shimoe Y, Fukushima T, Matsubara E. Vascular Risk Factors and Internal Jugular Venous Flow in Transient Global Amnesia: A Study of 165 Japanese Patients. J Stroke Cerebrovasc Dis 2017; 26:2272-2278. [PMID: 28669658 DOI: 10.1016/j.jstrokecerebrovasdis.2017.05.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 05/03/2017] [Accepted: 05/07/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The etiology of transient global amnesia (TGA) remains unclear. We studied the pathophysiology of TGA in 165 Japanese patients. SUBJECTS AND METHODS TGA was diagnosed in hospitalized patients from 2004 to 2015. We analyzed clinical characteristics, magnetic resonance imaging findings, and maximum intima-media thickness of the common carotid artery, and the reflux of internal jugular venous (IJV) flow by ultrasonography, and statistically compared patients with TGA with age-matched and sex-matched patients who have had a transient ischemic attack (TIA), small-vessel occlusion (SVO), and normal controls (each group, N = 165). RESULTS Patients with TGA showed lower prevalence of vascular risk factors than patients with TIA and SVO did. Eleven patients (6.7%) had 2 episodes of TAG, but specific clinical variables could not be recognized in these patients. The maximum intima-media thickness was significantly thinner in TGA (1.1 ± .7 mm) than in SVO (1.6 ± .9 mm; P = .001). The percentages of cases whose IJV flow reflux was increased by Valsalva maneuver showed no difference (P = .573) between TGA (26.0 %) and SVO (29.4%). MR diffusion-weighted imaging yielded small hyperintense signals in the hippocampus in 64 of 90 (71.1%) patients between 24 and 72 hours. Potential precipitating specific factors or events before the attacks could be recognized in 40 cases (24.2%) of 165 patients. CONCLUSION Arterial ischemia and IJV flow reflux might not contribute to TGA pathophysiology. The vulnerability of the hippocampus to physical or emotional stress might be suspected as an underlying mechanism in some patients with TGA.
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Affiliation(s)
- Takahiro Himeno
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, Hiroshima, Japan; Department of Neurology, Faculty of Medicine, Oita University, Oita, Japan
| | - Masaru Kuriyama
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, Hiroshima, Japan.
| | - Makoto Takemaru
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, Hiroshima, Japan; Department of Neurology, Faculty of Medicine, Oita University, Oita, Japan
| | - Yuhei Kanaya
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, Hiroshima, Japan
| | - Yuji Shiga
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, Hiroshima, Japan
| | - Shinichi Takeshima
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, Hiroshima, Japan
| | - Kazuhiro Takamatsu
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, Hiroshima, Japan
| | - Yutaka Shimoe
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, Hiroshima, Japan
| | - Tomoko Fukushima
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, Hiroshima, Japan
| | - Etsuro Matsubara
- Department of Neurology, Faculty of Medicine, Oita University, Oita, Japan
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Mariaca AF, Valdueza JM, Gaebel C, Gomez-Choco M. Simultaneous transient global amnesia and right MCA stroke after Valsalva manoeuvre. BMJ Case Rep 2017; 2017:bcr-2016-218990. [PMID: 28433970 DOI: 10.1136/bcr-2016-218990] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 61-year-old man suffered an episode of transient confusion and anterograde amnesia after a Valsalva-related manoeuvre. The MRI diffusion weighted imaging (DWI) sequences showed a left hippocampal and two right parietal lesions that were deemed as acute. The MR angiography disclosed a high-grade stenosis in the right middle cerebral artery as was described by a transcranial colour-coded ultrasound as well. Ultrasound investigation of the jugular veins showed a right jugular venous reflux after a Valsalva manoeuvre. The patient was diagnosed with transient global amnesia based on clinical grounds and the right parietal lesions were considered as silent strokes. The Valsalva manoeuvre could have played as a common trigger for both diseases.
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Affiliation(s)
| | | | - Christian Gaebel
- Radiology, Neurological Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Manuel Gomez-Choco
- Department of Neurology, Hospital Sant Joan Despi Moises Broggi, Sant Joan Despi, Spain
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14
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Roh GU, Kim WO, Rha KH, Lee BH, Jeong HW, Na S. Prevalence and impact of incompetence of internal jugular valve on postoperative cognitive dysfunction in elderly patients undergoing robot-assisted laparoscopic radical prostatectomy. Arch Gerontol Geriatr 2016; 64:167-71. [PMID: 26921505 DOI: 10.1016/j.archger.2016.01.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 01/21/2016] [Accepted: 01/22/2016] [Indexed: 11/29/2022]
Abstract
Internal jugular vein (IJV) is the main pathway of cerebral venous drainage and its valves prevent regurgitation of blood to the brain. IJV valve incompetence (IJVVI) is known to be associated with cerebral dysfunctions. It occurs more often in male over 50 years old, conditions elevating intra-abdominal or intra-thoracic pressure. In robot-assisted laparoscopic radical prostatectomy (RALRP), elderly male undergoes surgery in Trendelenburg position with pneumoperitoneum applied. Therefore, we assessed the IJVVI during RALRP and its influence on postoperative cognitive function. 57 patients undergoing RALRP were enrolled. Neurocognitive tests including Mini-Mental State Examination (MMSE), Auditory Verbal Learning Test, Digit Symbol Substitution Test, Color Word Stroop Test, digit span test, and grooved pegboard test were performed the day before and 2 days after surgery. During surgery, IJVVI was assessed with ultrasonography in supine position with and without pneumoperitoneum, and Trendelenburg position with pneumoperitoneum. 50 patients underwent sonographic assessment and 41 patients completed neurocognitive examination. A total of 27 patients presented IJVVI, 19 patients in supine position without pneumoperitoneum, 7 patients in supine position with pneumoperitoneum and 1 patient in Trendelenburg position with pneumoperitoneum. In neurocognitive tests, patients with IJVVI showed statistically significant decline of score in MMSE postoperatively (p<0.05). IJVVI occurred in 38% in supine position but the incidence was increased to 54% after Trendelenburg position and pneumoperitoneum. Patients with IJVVI did not show significant differences in cognitive function tests except MMSE. Clinical and neurological significance of physiologic changes associated RALRP should be studied further.
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Affiliation(s)
- Go Un Roh
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164, World Cup-ro, Yeongtong-gu, Suwon 443-380, South Korea
| | - Won Oak Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea
| | - Koon Ho Rha
- Department of Urology, Urological Science Institute and Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea
| | - Byung Ho Lee
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164, World Cup-ro, Yeongtong-gu, Suwon 443-380, South Korea
| | - Hae Won Jeong
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164, World Cup-ro, Yeongtong-gu, Suwon 443-380, South Korea
| | - Sungwon Na
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea.
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15
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Khan R, Hossain MA, Nai Q, Yousif AM, Sen S. Hyperhomocysteinemia Association With Transient Global Amnesia: A Rare Case Report. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2015; 7:374-6. [PMID: 26417562 PMCID: PMC4561445 DOI: 10.4103/1947-2714.163647] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Context: Transient global amnesia (TGA) is an intriguing condition that classically presents with an abrupt onset of temporary complete anterograde amnesia and partial retrograde amnesia. Most individuals who experience such a form of amnesia usually have only one attack but recurrent attacks are possible. Most attacks last for a few minutes or few hours and the ability to lay down new memories may also be affected but gradually improves, leaving only a dense amnestic gap for the duration of the episode. There has been some discussion about the etiology behind TGA; however, there has yet to be a consensus with regard to any significant association. Case Report: We report the case of a 65-year-old male presenting with a sudden onset of memory loss that is typical of TGA and who was found to have elevated homocysteine levels. There has only been one other case previously reported that discussed a possible correlation between hyperhomocysteinemia and TGA. It is yet to be determined if increased homocysteine level is a significant risk factor for attacks of TGA. Conclusion: Although it was first described more than half a century ago, it can still be misdiagnosed frequently as many physicians are not familiar with this condition. Furthermore, there are quite a few medical conditions that may cause sudden memory impairment, such as epilepsy and stroke, which make it difficult to distinguish them from this form of amnesia. The knowledge of these clinical identities is necessary for a high index of suspicion, which may lead to a meticulous medical evaluation as required for proper diagnosis.
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Affiliation(s)
- Rafay Khan
- Department of Internal Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, USA
| | - Mohammad A Hossain
- Department of Internal Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, USA
| | - Qiang Nai
- Department of Internal Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, USA
| | - Abdalla M Yousif
- Department of Internal Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, USA
| | - Shraman Sen
- Department of Internal Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, USA
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Donnet A. Transient Global Amnesia Triggered by Migraine in a French Tertiary-Care Center: An 11-Year Retrospective Analysis. Headache 2015; 55:853-9. [PMID: 25877480 DOI: 10.1111/head.12545] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The etiology of transient global amnesia (TGA) remains unclear, and flow disturbances in the mesial temporal lobes secondary to venous congestion have been proposed as a potential cause. The occurrence of TGA during a migraine attack is a rare condition. METHODS This 11-year retrospective study in one French center describes patients' characteristics, type of migraine, investigations, treatment with vasoconstrictor during the TGA/migraine attack, and outcome in patients who had TGA during a migraine attack. RESULTS Among 8821 new patients, 6 cases of TGA occurring during a migraine attack were identified. For a majority of patients, TGA occurs after the beginning of the attack. TGA always occurs during a severe migraine attack, with vomiting or vomiting efforts. Vomiting or vomiting efforts always precede a TGA episode. CONCLUSIONS TGA occurring during a migraine attack is rare. Since a Valsalva maneuver, such as forceful vomiting, is frequently described at the origin of the attack, blocking venous return through the superior venous cava may allow brief retrograde transmission of high venous pressure from the arms to the cerebral venous system, resulting in venous ischemia to the diencephalon or mesial temporal lobes and causing TGA.
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Affiliation(s)
- Anne Donnet
- Centre d'Evaluation et de Traitement de la Douleur, Hôpital Timone, Marseille, France
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17
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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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18
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Arena JE, Rabinstein AA. Transient global amnesia. Mayo Clin Proc 2015; 90:264-72. [PMID: 25659242 DOI: 10.1016/j.mayocp.2014.12.001] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 11/24/2014] [Accepted: 12/01/2014] [Indexed: 11/20/2022]
Abstract
Transient global amnesia (TGA) is a clinical syndrome characterized by the sudden onset of anterograde amnesia (the inability to encode new memories), accompanied by repetitive questioning, sometimes with a retrograde component, lasting up to 24 hours, without compromise of other neurologic functions. Herein, we review current knowledge on the epidemiology, pathophysiology, clinical diagnosis, and prognosis of TGA. For this review, we conducted a literature search of PubMed, with no date limitations, using the following search terms (or combinations of them): transient global amnesia, etiology, pathophysiology, venous hypertension, migraine, magnetic resonance imaging, computed tomography, electroencephalography, prognosis, and outcome. We also reviewed the bibliography cited in the retrieved articles. Transient global amnesia is a clinical diagnosis, and recognition of its characteristic features can avoid unnecessary testing. Several pathophysiologic mechanisms have been proposed (venous insufficiency, arterial ischemia, and migrainous or epileptic phenomena), but none of them has been proved to consistently explain cases of TGA. Brain imaging may be considered and electroencephalography is recommended when episodes are brief and recurrent, but otherwise no investigations are necessary in most cases. Data on long-term prognosis are limited, but available information suggests that the relapse rate is low, the risk of stroke and seizures is not considerably increased, and cognitive outcome is generally good.
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19
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Kang Y, Kim E, Kim JH, Choi BS, Jung C, Bae YJ, Lee KM, Lee DH. Time of flight MR angiography assessment casts doubt on the association between transient global amnesia and intracranial jugular venous reflux. Eur Radiol 2014; 25:703-9. [PMID: 25278248 DOI: 10.1007/s00330-014-3448-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 09/01/2014] [Accepted: 09/17/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Evidence of intracranial venous reflux flow due to jugular venous reflux (JVR) on time of flight (TOF) MR angiography (MRA) is thought to be highly associated with transient global amnesia (TGA)-evidence that supports the venous congestion theory of TGA pathophysiology. However, recent studies indicate that intracranial JVR on TOF MRA is occasionally observed in normal elderly. Therefore, the purpose of this study was to compare the prevalence of intracranial JVR on TOF MRA in patients with TGA and two control groups. METHODS Three age- and sex-matched groups of subjects that received MRI and MRA were enrolled. The groups comprised 167 patients with TGA, 167 visitors to the emergency room (ER) and 167 visitors to a health promotion centre (HPC). Intracranial JVR was defined as abnormal venous signals in the inferior petrosal, sigmoid and/or transverse sinuses on TOF MRA. The prevalence of intracranial JVR was assessed across the three groups. RESULTS Intracranial JVR was seen in seven (4.2 %) TGA patients, eight (4.8 %) ER visitors and three (1.8 %) HPC visitors, respectively. No statistically significant differences were observed among the three groups. CONCLUSION TGA patients showed a low prevalence of intracranial JVR on TOF MRA, and no statistical differences were found in comparison with control groups.
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Affiliation(s)
- Yeonah Kang
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Korea
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20
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Baracchini C, Farina F, Ballotta E, Meneghetti G, Manara R. No signs of intracranial arterial vasoconstriction in transient global amnesia. J Neuroimaging 2014; 25:92-6. [PMID: 24571186 DOI: 10.1111/jon.12090] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Revised: 10/18/2013] [Accepted: 11/19/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE The current theories to explain the pathophysiology of transient global amnesia (TGA) involve epilepsy, migraine, and hippocampal ischemia which might be determined by venous congestion or arterial vasoconstriction triggered by Valsalva-associated maneuvers in susceptible individuals. METHODS Seventy-five TGA patients [mean age 60.3 ± 8.0 years, 44 (59%) females] and 75 age- and gender-matched controls were enrolled into a case-control study and underwent extracranial and transcranial arterial echo-color Doppler sonography. RESULTS Intracranial arterial obstructions of the posterior circulation were neither observed in TGA patients nor in controls. There was no significant difference between the two groups with regard to intima-media thickness of the common carotids (.73 ± .07 vs. .72 ± .06), cervical vessel atherosclerosis (13% vs. 15%), >50% intracranial stenosis of the anterior circulation arteries (3% vs. 3%), resistance index values of the vertebral arteries at rest and during Valsalva maneuver (.69 ± .08 vs. .67 ± .09) and pulsatility index values of the major intracranial arteries at rest and during Valsalva maneuver. No difference in all study items was found between patients assessed during or soon after the TGA episode. CONCLUSIONS Extra-intracranial atherosclerosis does not play a pathogenic role in TGA and no supporting evidence for the arterial vasoconstriction hypothesis of TGA emerged from this study.
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Affiliation(s)
- Claudio Baracchini
- Department of Neurological Sciences, University of Padua School of Medicine, Padua-Italy
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Zivadinov R, Chung CP. Potential involvement of the extracranial venous system in central nervous system disorders and aging. BMC Med 2013; 11:260. [PMID: 24344742 PMCID: PMC3866257 DOI: 10.1186/1741-7015-11-260] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 11/22/2013] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The role of the extracranial venous system in the pathology of central nervous system (CNS) disorders and aging is largely unknown. It is acknowledged that the development of the venous system is subject to many variations and that these variations do not necessarily represent pathological findings. The idea has been changing with regards to the extracranial venous system. DISCUSSION A range of extracranial venous abnormalities have recently been reported, which could be classified as structural/morphological, hemodynamic/functional and those determined only by the composite criteria and use of multimodal imaging. The presence of these abnormalities usually disrupts normal blood flow and is associated with the development of prominent collateral circulation. The etiology of these abnormalities may be related to embryologic developmental arrest, aging or other comorbidities. Several CNS disorders have been linked to the presence and severity of jugular venous reflux. Another composite criteria-based vascular condition named chronic cerebrospinal venous insufficiency (CCSVI) was recently introduced. CCSVI is characterized by abnormalities of the main extracranial cerebrospinal venous outflow routes that may interfere with normal venous outflow. SUMMARY Additional research is needed to better define the role of the extracranial venous system in relation to CNS disorders and aging. The use of endovascular treatment for the correction of these extracranial venous abnormalities should be discouraged, until potential benefit is demonstrated in properly-designed, blinded, randomized and controlled clinical trials.
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Affiliation(s)
- Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.
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22
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Rabe K, Küper M, Holle D, Savidou I, Kastrup O, Jähne-Blasberg A, Diener HC, Katsarava Z, Frings M. No evidence of jugular venous valve insufficiency in patients with migraine – a controlled study. J Headache Pain 2013; 14:52. [PMID: 23782952 PMCID: PMC3691823 DOI: 10.1186/1129-2377-14-52] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 06/12/2013] [Indexed: 12/20/2022] Open
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Tromba L, Blasi S, Vestri A, Kiltzanidi D, Tartaglia F, Redler A. Prevalence of chronic cerebrospinal venous insufficiency in multiple sclerosis: a blinded sonographic evaluation. Phlebology 2013; 30:52-60. [DOI: 10.1177/0268355513512823] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: To verify the prevalence of chronic cerebrospinal venous insufficiency in patients affected by different clinical forms of multiple sclerosis and in healthy subjects using the Zamboni ultrasound protocol combined with M-mode ultrasound examination. Materials and methods: We enrolled 112 patients with multiple sclerosis and 67 healthy subjects from 20 to 67 years of age. All the patients underwent Duplex and color-Doppler sonography of the neck vessels, transcranial colour duplex sonography, M-mode study of the valve system and of venous abnormalities. Subjects were positive for chronic cerebrospinal venous insufficiency when at least two of five hemodynamic criteria of the Zamboni protocol were fulfilled. Chronic cerebrospinal venous insufficiency condition was further analyzed by a multivariate analysis including age, sex, disease duration, subtypes of multiple sclerosis and expanded disability status scale score as independent variables. Results: No healthy subjects was positive for chronic cerebrospinal venous insufficiency, while in the sample of patients affected by multiple sclerosis the diagnosis was made in 59.8% of cases ( p < 0.0001). The first criterion was the most frequent in patients affected by multiple sclerosis and chronic cerebrospinal venous insufficiency (respectively 54.4% and 76.1%, p < 0.001). The second, third and fourth criteria were never present in healthy subjects but were detected in patients with multiple sclerosis. The positivity of the second criterion was associated with diagnosis of chronic cerebrospinal venous insufficiency in 100% of cases. The third criterion had a prevalence of 52.2% in the subgroup of chronic cerebrospinal venous insufficiency patients. It was positive in 36 multiple sclerosis patients and was associated with chronic cerebrospinal venous insufficiency diagnosis in all cases except one. The multivariate analysis showed that age, disease duration, sex, subtypes of multiple sclerosis and expanded disability status scale score were not considered predictors of this haemodynamic condition. Conclusion: Chronic cerebrospinal venous insufficiency is a haemodynamic condition strongly associated with multiple sclerosis and is not found in normal controls. The addition of M-mode ultrasound to the diagnostic protocol allows improved observation of venous valve abnormalities.
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Affiliation(s)
- L Tromba
- Department of Surgical Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - S Blasi
- Department of Surgical Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - A Vestri
- Department of Public health and infectious diseases, Sapienza University, Rome, Italy
| | - D Kiltzanidi
- Department of Surgical Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - F Tartaglia
- Department of Surgical Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - A Redler
- Department of Surgical Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
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Domitrz I, Styczynski G, Wilczko J, Gadomska L, Parzuchowska B, Domitrz W, Kaminska A. Internal jugular vein valve insufficiency is not increased in migraine: an ultrasound study in migraine patients and control participants. J Headache Pain 2013; 14:78. [PMID: 24059639 PMCID: PMC3848788 DOI: 10.1186/1129-2377-14-78] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 09/20/2013] [Indexed: 11/17/2022] Open
Abstract
Background Migraine is a common neurological disorder of unclear pathogenesis. Recently incompetence of internal jugular vein valve (IJVVI) was found to be associated with some neurological conditions of unknown etiology such as benign cough headache, primary exertional headache or transient global amnesia. Common vascular mechanism linking transiently increased cerebral venous pressure with the above mentioned conditions was then postulated. Therefore we decided to investigate whether IJVVI may be associated with migraine. Aim and methods The aim of our study was to evaluate the occurrence of IJVVI and retrograde flow duration in 70 (56 females) migraine patients by color Doppler ultrasound during Valsalva maneuver. We assessed internal jugular vein valve in 44 patients with migraine without aura (39 female); mean age 37 ± 9 yrs. and in 26 patients with migraine with typical aura (17 female); mean age 34 ± 9 yrs. Age- and sex-matched control group consisted of 42 healthy persons (33 female); mean age 32 ± 1 yrs. Results Frequency of the internal jugular vein valve insufficiency was similar in patients with migraine and in the healthy subjects (51% v. 40%, p = 0.26). Also mean values of retrograde flow duration were similar in both groups (2.4 ± 0.8 sec in migraine group and 2.2 ± 1.2 sec in controls, p = 0.14). Conclusion The results of our study show no evidence for an increased prevalence of IJVVI in migraine patients.
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Affiliation(s)
- Izabela Domitrz
- Department of Neurology, Medical University of Warsaw, 1a Banacha Street, 02-097 Warsaw, Poland.
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Lochner P, Nedelmann M, Kaps M, Stolz E. Jugular Valve Incompetence in Transient Global Amnesia. A Problem Revisited. J Neuroimaging 2013; 24:479-83. [DOI: 10.1111/jon.12042] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 05/07/2013] [Accepted: 05/09/2013] [Indexed: 11/30/2022] Open
Affiliation(s)
- Piergiorgio Lochner
- Department of Neurology; Justus-Liebig University; Giessen Germany
- Department of Neurology; Krankenhaus Meran; Meran Italy
| | - Max Nedelmann
- Department of Neurology; Justus-Liebig University; Giessen Germany
| | - Manfred Kaps
- Department of Neurology; Justus-Liebig University; Giessen Germany
| | - Erwin Stolz
- Department of Neurology; Caritasklinikum Saarbruecken; Saarbruecken Germany
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Sakai T, Tomimoto H. [Neuroimaging of a 39-year-old woman with transient global amnesia accompanied by cerebral venous reflow abnormalities]. Rinsho Shinkeigaku 2012; 52:769-73. [PMID: 23064628 DOI: 10.5692/clinicalneurol.52.769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We present a 39-year-old woman with transient global amnesia (TGA) who showed sudden onset amnesia immediately following sexual intercourse after taking a bath. Her amnesia resolved within 6 hours. Three-Tesla (3T) diffusion weighted magnetic resonance imaging (DWI) taken 80 hours after the onset revealed hyperintense spots in the CA1 subfields of the bilateral hippocampi. No abnormalities were noted in 3T DWI, T(2) weighted imaging (T(2) WI) and fluid attenuated inversion recovery (FLAIR) at 3 weeks after the onset. She had no cardiovascular diseases. Magnetic resonance venography (MRV) revealed hypoplasia of the right transverse sinus and stenosis of the bilateral brachiocephalic veins. Ultrasound sonographic studies revealed a prolonged retrograde flow component of the right internal jugular vein during a Valsalva maneuver. The vast majority of TGA attacks occur between the ages of 50 and 80, and very rarely under the age of 40 years, which is mostly not exposed to vascular risks. We therefore speculate that in conjunction with a decreased vascular beds from the brain, a Valsalva-like maneuver might have precipitated cerebral venous ischemia in the bilateral hippocampi, which are the most vulnerable to ischemic insults.
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Affiliation(s)
- Toshiyuki Sakai
- Department of Neurology, Saiseikai Matsusaka General Hospital
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Modabbernia A, Taslimi S, Ashrafi M, Modabbernia MJ, Hu HH. Internal jugular vein reflux in patients with transient global amnesia: a meta-analysis of case-control studies. Acta Neurol Belg 2012; 112:237-44. [PMID: 22553002 DOI: 10.1007/s13760-012-0072-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Accepted: 04/14/2012] [Indexed: 10/28/2022]
Abstract
Our aim was to quantitatively evaluate the role of internal jugular venous reflux (IJVR) in transient global amnesia (TGA). Meta-analysis of case-control studies was conducted using Medline, Current contents connect, ISI Web of Knowledge, Biological abstracts and Scopus, plus citations of selected studies. We performed sensitivity and subgroup analyses to assess the effect of methods of IJVR determination, blinding of studies, and definition of IJVR on the results. Seven studies were included in the first meta-analysis which investigated the frequency of IJVR in 312 patients and 261 controls. IJVR was more common in patients (OR 5.867, 95% CI 3.895-8.838,). Meta-analysis of blinded studies did not alter our results (OR 10.894, 95% CI 5.396-21.996). Another meta-analysis with seven studies was performed in which, IJVR was more frequent in patients with TGA and precipitating factors compared with those without any identifiable precipitating factors (OR 2.889, 95% CI 1.748-4.777). IJVR is a risk factor for TGA. However, not all patients with history of TGA spells had IJVR and this, together with higher frequency of IJVR in patients with TGA who experienced precipitating events, showed the need of considering several other factors in further primary researches.
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Baracchini C, Tonello S, Farina F, Viaro F, Atzori M, Ballotta E, Manara R. Jugular Veins in Transient Global Amnesia. Stroke 2012; 43:2289-92. [PMID: 22811457 DOI: 10.1161/strokeaha.112.654087] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Claudio Baracchini
- From the Department of Neurological Sciences, University of Padua School of Medicine, Padua, Italy (C.B., F.F., F.V., M.A., R.M.); the Division of Neurology, Treviso Regional Hospital, Treviso, Italy (S.T.); and the Vascular Surgery Section, Geriatric Surgery Clinic, Department of Surgical and Gastroenterological Sciences, University of Padua, School of Medicine, Padua, Italy (E.B.)
| | - Simone Tonello
- From the Department of Neurological Sciences, University of Padua School of Medicine, Padua, Italy (C.B., F.F., F.V., M.A., R.M.); the Division of Neurology, Treviso Regional Hospital, Treviso, Italy (S.T.); and the Vascular Surgery Section, Geriatric Surgery Clinic, Department of Surgical and Gastroenterological Sciences, University of Padua, School of Medicine, Padua, Italy (E.B.)
| | - Filippo Farina
- From the Department of Neurological Sciences, University of Padua School of Medicine, Padua, Italy (C.B., F.F., F.V., M.A., R.M.); the Division of Neurology, Treviso Regional Hospital, Treviso, Italy (S.T.); and the Vascular Surgery Section, Geriatric Surgery Clinic, Department of Surgical and Gastroenterological Sciences, University of Padua, School of Medicine, Padua, Italy (E.B.)
| | - Federica Viaro
- From the Department of Neurological Sciences, University of Padua School of Medicine, Padua, Italy (C.B., F.F., F.V., M.A., R.M.); the Division of Neurology, Treviso Regional Hospital, Treviso, Italy (S.T.); and the Vascular Surgery Section, Geriatric Surgery Clinic, Department of Surgical and Gastroenterological Sciences, University of Padua, School of Medicine, Padua, Italy (E.B.)
| | - Matteo Atzori
- From the Department of Neurological Sciences, University of Padua School of Medicine, Padua, Italy (C.B., F.F., F.V., M.A., R.M.); the Division of Neurology, Treviso Regional Hospital, Treviso, Italy (S.T.); and the Vascular Surgery Section, Geriatric Surgery Clinic, Department of Surgical and Gastroenterological Sciences, University of Padua, School of Medicine, Padua, Italy (E.B.)
| | - Enzo Ballotta
- From the Department of Neurological Sciences, University of Padua School of Medicine, Padua, Italy (C.B., F.F., F.V., M.A., R.M.); the Division of Neurology, Treviso Regional Hospital, Treviso, Italy (S.T.); and the Vascular Surgery Section, Geriatric Surgery Clinic, Department of Surgical and Gastroenterological Sciences, University of Padua, School of Medicine, Padua, Italy (E.B.)
| | - Renzo Manara
- From the Department of Neurological Sciences, University of Padua School of Medicine, Padua, Italy (C.B., F.F., F.V., M.A., R.M.); the Division of Neurology, Treviso Regional Hospital, Treviso, Italy (S.T.); and the Vascular Surgery Section, Geriatric Surgery Clinic, Department of Surgical and Gastroenterological Sciences, University of Padua, School of Medicine, Padua, Italy (E.B.)
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Font MÀ, Krupinski J, Arboix A. Antithrombotic medication for cardioembolic stroke prevention. Stroke Res Treat 2011; 2011:607852. [PMID: 21822469 PMCID: PMC3148601 DOI: 10.4061/2011/607852] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 03/02/2011] [Accepted: 03/27/2011] [Indexed: 01/28/2023] Open
Abstract
Embolism of cardiac origin accounts for about 20% of ischemic strokes. Nonvalvular atrial fibrillation is the most frequent cause of cardioembolic stroke. Approximately 1% of population is affected by atrial fibrillation, and its prevalence is growing with ageing in the modern world. Strokes due to cardioembolism are in general severe and prone to early recurrence and have a higher long-term risk of recurrence and mortality. Despite its enormous preventive potential, continuous oral anticoagulation is prescribed for less than half of patients with atrial fibrillation who have risk factors for cardioembolism and no contraindications for anticoagulation. Available evidence does not support routine immediate anticoagulation of acute cardioembolic stroke. Anticoagulation therapy's associated risk of hemorrhage and monitoring requirements have encouraged the investigation of alternative therapies for individuals with atrial fibrillation. New anticoagulants being tested for prevention of stroke are low-molecular-weight heparins (LMWH), unfractionated heparin, factor Xa inhibitors, or direct thrombin inhibitors like dabigatran etexilate and rivaroxaban. The later exhibit stable pharmacokinetics obviating the need for coagulation monitoring or dose titration, and they lack clinically significant food or drug interaction. Moreover, they offer another potential that includes fixed dosing, oral administration, and rapid onset of action. There are several concerns regarding potential harm, including an increased risk for hepatotoxicity, clinically significant bleeding, and acute coronary events. Therefore, additional trials and postmarketing surveillance will be needed.
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Affiliation(s)
- M. Àngels Font
- Institut d'Investigacions Biomèdiques de Bellvitge (IDIBELL), Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, 08907 Barcelona, Spain
- Department of Neurology, Hospital Sant Joan de Déu de Manresa (Fundació Althaia), Catalonia, 08243 Manresa, Spain
| | - Jerzy Krupinski
- Department of Neurology, Cerebrovascular Diseases Unit, Hospital Universitari Mútua de Terrassa, Catalonia, 08227 Terrassa, Spain
| | - Adrià Arboix
- Cerebrovascular Division, Department of Neurology, Hospital Universitari Sagrat Cor, University of Barcelona, C/Viladomat 288, Catalonia, 08029 Barcelona, Spain
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Auyeung M, Tsoi T, Cheung C, Fong DY, Li R, Chan JK, Lau K. Association of diffusion weighted imaging abnormalities and recurrence in transient global amnesia. J Clin Neurosci 2011; 18:531-4. [DOI: 10.1016/j.jocn.2010.08.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 05/13/2010] [Accepted: 08/02/2010] [Indexed: 10/18/2022]
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Mohr J, Binder JR. Posterior Cerebral Artery Disease. Stroke 2011. [DOI: 10.1016/b978-1-4160-5478-8.10025-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Incompetence of internal jugular vein valve in patients with transient global amnesia. VOJNOSANIT PREGL 2011; 68:35-40. [DOI: 10.2298/vsp1101035j] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background/Aim. Transient global amnesia (TGA) could be related to acute
ischemic disturbances in mesial parts of temporal lobes, which are important
for memory. Incompetence of internal jugular vein (IJV) valve with venous
congestion causes venous microthrombosis of hippocampus. The aim of this
study was to investigate the frequency of IJV valve incompetence, as well as
other hemodynamic and structural properties of cerebral circulation in TGA
patients. Methods. IJV valve competence was investigated in 40 TGA patients
and 30 persons of the control group (matched by age and sex), as well as
detection of microembolic signals and detection of right to left
cardiopulmonal shunt, cerebral vasomotor reactivity and echocardiography by
color triplex ultrasonography and transcranial doppler. Results. A
significant difference in frequency of IJV valve incompetence was found
between the TGA patients and the control persons (55% TGA vs 30% controls; p
< 0.001). We did not find a significant structural (plaques frequency) or
hemodynamic (flow velocity, pulsatility index) differences on arteries of the
neck and cerebral arteries between the TGA patients and the controls, except
for the increased pulsatility index on the basilar artery (40% TGA vs 16.6%
controls; p < 0.01) and decreased vasomotor reactivity in TGA patients (50%
TGA vs 26.6% controls; p < 0.001). Microembolic signals were detected very
rarely (17.5% TGA patients vs 13.3% controls; p > 0.05), as well as right to
left cardiopulmonal shunt (15% TGA vs 16.6% controls; p > 0.05), indicating
that embolism was not important for pathogenesis of TGA. Transesophageal
echocardiography confirmed it, because only one TGA patient had a potent
foramen ovale. Conclusion. We found a significantly increased frequency of
IJV incompetence in the TGA patients, which confirmed the role of vein
drainage disturbances in pathogenesis of TGA.
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Albano B, Gandolfo C, Del Sette M. Post-coital intra-cerebral venous hemorrhage in a 78-year-old man with jugular valve incompetence: a case report. J Med Case Rep 2010; 4:225. [PMID: 20659320 PMCID: PMC2918629 DOI: 10.1186/1752-1947-4-225] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Accepted: 07/26/2010] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Spontaneous intra-cerebral hemorrhage can occur in patients with venous disease due to obstructed venous outflow. CASE PRESENTATION We report the case of a 78-year-old Caucasian man with jugular valve incompetence who experienced an intra-cerebral temporo-occipital hemorrhage following sexual intercourse. He had no other risk factors for an intra-cerebral hemorrhage. CONCLUSIONS To the best of our knowledge, this is the first case of intra-cerebral hemorrhage due to jugular valve incompetence in association with the physical exertion associated with sexual intercourse.
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de Francisco J, Pujadas F, Toledo M, Santamarina E, Quintana M, Edo M, Centeno M, Álvarez Sabín J. A study of right-left shunt in transient global amnesia. NEUROLOGÍA (ENGLISH EDITION) 2010. [DOI: 10.1016/s2173-5808(10)70017-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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de Francisco J, Pujadas F, Toledo M, Santamarina E, Quintana M, Edo M, Centeno M, Álvarez Sabín J. Estudio de shunt derecha-izquierda en la amnesia global transitoria. Neurologia 2010. [DOI: 10.1016/s0213-4853(10)70031-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Affiliation(s)
- Thorsten Bartsch
- Department of Neurology, University Hospital Schleswig-Holstein, University of Kiel, Kiel, Germany.
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Altamura C, Vernieri F. Internal Jugular Vein Valve Incompetence in Transient Global Amnesia. Stroke 2010; 41:1-2. [DOI: 10.1161/strokeaha.109.569582] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Claudia Altamura
- From the Neurologia Clinica, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Fabrizio Vernieri
- From the Neurologia Clinica, Università Campus Bio-Medico di Roma, Rome, Italy
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Cejas C, Cisneros LF, Lagos R, Zuk C, Ameriso SF. Internal jugular vein valve incompetence is highly prevalent in transient global amnesia. Stroke 2009; 41:67-71. [PMID: 19926838 DOI: 10.1161/strokeaha.109.566315] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Transient global amnesia (TGA) is the inability to retain new information and to recall past events during a period of minutes or hours. Its etiology is unclear, and flow disturbances in the mesial temporal lobes secondary to venous congestion have been proposed as a potential cause. Ultrasonographic evaluation of the internal jugular vein (IJV) has demonstrated valvular insufficiency in TGA. The prevalence of valvular insufficiency in the IJV in patients with TGA was assessed. Subjects without TGA of similar sex, age, and vascular risk factor profiles served as controls. METHODS A group of 142 patients with a clinical diagnosis of TGA within 7 days of the clinical event and 40 controls were prospectively evaluated. Venous Doppler examination of both IJVs was performed at baseline and after a manometer-controlled Valsalva maneuver. Valvular insufficiency was diagnosed when there was reflux for >0.8 seconds during the Valsalva maneuver. RESULTS Valve insufficiency was found in at least one jugular vein in 113 of 142 patients with TGA (79.5%) and in 10 of 40 controls (25.0%), P<0.01. The right side was affected more often than the left side, P<0.01, and 26.8% of the patients had bilateral incompetence. CONCLUSIONS Patients with TGA have a high prevalence of IJV valve insufficiency. This finding may have pathophysiologic implications. Doppler evaluation of the IJVs with dynamic maneuvers may help in the evaluation of this usually benign condition.
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Affiliation(s)
- Claudia Cejas
- Institute for Neurological Research, FLENI, Neurology Department, Montañeses 2325, C1428AQK, Buenos Aires, Argentina
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Doepp F, Bähr D, John M, Hoernig S, Valdueza JM, Schreiber SJ. Internal jugular vein valve incompetence in COPD and primary pulmonary hypertension. JOURNAL OF CLINICAL ULTRASOUND : JCU 2008; 36:480-484. [PMID: 18335510 DOI: 10.1002/jcu.20470] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE Under physiologic conditions, intact internal jugular vein valves (IJVVs) efficiently prevent retrograde venous flow during intrathoracic pressure increase. Chronically elevated central venous pressure found in patients with chronic obstructive pulmonary disease (COPD) and primary pulmonary hypertension (PPH) might lead to IJVV incompetence (IJVVI). The aim of this study was to analyze the prevalence of IJVVI in patients with COPD and PPH using duplex sonography (DUS). METHOD We included 30 COPD patients, 5 PPH patients, and 100 healthy controls in the study. IJVVI was diagnosed if retrograde jugular blood flow was seen on DUS during a Valsalva maneuver. Retrograde venous flow intensity was evaluated and graded according to extent and duration of reflux. RESULTS IJVVI was found in 18 (60%) COPD patients and in all 5 (100%) PPH patients, which was significantly different from the controls (27%; p < 0.005). The intensity of venous retrograde flow correlated with the pulmonary artery pressure. CONCLUSION Compared with healthy controls, COPDand PPH patients demonstrated a significantlygreater prevalence of IJVVI, which seems to be caused by the elevated central venous pressure. These patients may be at higher risk to develop central nervous system diseases related to cerebral outflow obstruction.
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Affiliation(s)
- Florian Doepp
- Department of Neurology, University Hospital Charité, Charitéplatz 1, 10117 Berlin, Germany
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Agosti C, Borroni B, Akkawi NM, De Maria G, Padovani A. Transient global amnesia and brain lesions: new hints into clinical criteria. Eur J Neurol 2008; 15:981-4. [DOI: 10.1111/j.1468-1331.2008.02250.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kuriyama N, Tokuda T, Miyamoto J, Takayasu N, Kondo M, Nakagawa M. Retrograde jugular flow associated with idiopathic normal pressure hydrocephalus. Ann Neurol 2008; 64:217-21. [DOI: 10.1002/ana.21410] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Yang Y, Kim S, Kim JH. Ischemic evidence of transient global amnesia: location of the lesion in the hippocampus. J Clin Neurol 2008; 4:59-66. [PMID: 19513305 PMCID: PMC2686867 DOI: 10.3988/jcn.2008.4.2.59] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2007] [Accepted: 05/23/2008] [Indexed: 11/17/2022] Open
Abstract
Background and purpose Transient global amnesia (TGA) is a rare amnestic syndrome characterized by the sudden onset of a selective anterograde and retrograde amnesia with a time course of up to 24 hours. Recent studies have found a high frequency of small high-signal abnormalities in the hippocampus on diffusion-weighted imaging (DWI), and accordingly ischemia has been proposed as an etiology of TGA. We hypothesized that TGA lesions occur preferentially in the CA1 region of the hippocampus, which is known to be susceptible to ischemia. Methods Twenty consecutive patients with a clinical diagnosis of TGA underwent DWI both within 24 hours of symptom onset and 3 days later. Twenty patients with high-signal abnormalities in the hippocampus on the initial DWI underwent subsequent DWI and T2-weighted imaging in the coronal plane to precisely localize the lesions. Results Seventeen patients had small high-signal abnormalities (with diameters of 1-3 mm) in the hippocampus unilaterally on DWI. One of these patients had two lesions in one hippocampus. Three of the 20 patients had lesions bilaterally in the hippocampus, 1 of whom had 3 bilateral lesions. A total of 25 lesions were identified: 5 in the hippocampal head, 19 in the body, and 1 in the tail. Six patients had unilateral lesions on the left,11 patients had them on the right, and 3 patients had bilateral lesions. Conclusions In this study, lesions associated with TGA were localized mostly to the lateral portion of the hippocampus, corresponding to CA1. This finding supports the ischemic etiology of TGA, but the underlying pathophysiologic mechanism requires further investigation.
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Affiliation(s)
- Youngsoon Yang
- Department of Neurology, Soonchunhyang University College of Medicine, Seoul, Korea
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Abstract
Transient global amnesia (TGA) is an isolated amnesic syndrome with normal neurological examination where patients remain alert and communicative with no loss of personal identity; however, they experience striking loss of memory for recent events and an impaired ability to retain new information. TGA could be triggered by venous congestion and there is evidence of association between younger patients and history of migraine. Most episodes last 2-12 h and the recurrence rate of future amnesic events is very low.
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Affiliation(s)
- R Shekhar
- Stroke Medicine, St Georges Hospital, London, UK.
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Hsu HY, Chao AC, Chen YY, Yang FY, Chung CP, Sheng WY, Yen MY, Hu HH. Reflux of jugular and retrobulbar venous flow in transient monocular blindness. Ann Neurol 2008; 63:247-53. [PMID: 18306412 DOI: 10.1002/ana.21299] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Transient monocular blindness (TMB) attacks may occur during straining activities that impede cerebral venous return. Disturbance of cerebral and orbital venous circulation may be involved in TMB. METHODS Duplex ultrasonography and Doppler-flow measurement of jugular and retrobulbar veins were performed in 134 consecutive patients with TMB and 134 age- and sex-matched control subjects. All recruited patients received thorough examinations to screen for possible underlying causes. RESULTS Of the 134 patients with TMB, 48 patients had ipsilateral carotid arterial lesion and 7 patients had TMB attack(s) caused by cardiac embolism. Of the remaining 79 patients with undetermined cause, 46 had 3 or more TMB attacks (undetermined-frequent group) and 33 had fewer than 3 attacks. In comparison with the control subjects, the TMB patients had greater frequencies of jugular venous reflux (57 vs 30%; p < 0.0001; odds ratio [OR]: 3.079, 95% confidence intervals [CI]: 1.861-5.096) and flow reversal in the superior ophthalmic vein (RSOV; 37 vs 9%; p < 0.0001; OR: 6.052, CI: 3.040-12.048). The undetermined-frequent group had the greatest frequencies of jugular venous reflux (74%, 34 patients; OR: 6.66, CI: 3.13-14.17) and RSOV (59%, 27 patients; OR: 6.51, CI: 3.12-13.58). Of the 50 patients with RSOV, 47 (94%) had RSOV on the side of the TMB attacks. INTERPRETATION The increased incidences of jugular and orbital venous reflux in TMB patients suggest that disturbance of cerebral and orbital venous circulation is involved in the pathogenesis of TMB, especially among patients with frequent attacks of undetermined cause.
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Affiliation(s)
- Hung-Yi Hsu
- Section of Neurology, Taichung Veterans General Hospital, Taichung, Taiwan
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Doepp F, Valdueza JM, Schreiber SJ. Incompetence of Internal Jugular Valve in Patients with Primary Exertional Headache: A Risk Factor? Cephalalgia 2007; 28:182-5. [PMID: 18021266 DOI: 10.1111/j.1468-2982.2007.01484.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The pathophysiology of primary exertional headache (EH) is unknown. Physical exertion is associated with Valsalva-like manoeuvres (VM). VM leads to increased intrathoracic pressure and reduces cerebral venous drainage. Internal jugular vein valve incompetence (IJVVI) leads to retrograde venous flow during VM with transient increase of intracranial pressure. We analysed the prevalence of IJVVI in EH patients using duplex ultrasound. Bilateral measurements were performed at rest and during VM in 20 patients and 40 controls. Incompetence was concluded if retrograde venous flow could be seen in the jugular Doppler spectrum during repeated VM. Seventy percent of EH patients and 20% of controls demonstrated IJVVI, yielding a significant difference ( P = 0.0004). IJVVI was always observed on the dominant venous drainage side. Our study suggests that intracranial venous congestion caused by retrograde jugular venous flow might play a role in the pathophysiology of EH with IJVVI as a risk factor.
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Affiliation(s)
- F Doepp
- Department of Neurology, University Hospital Charité, Humboldt University, Berlin
| | - JM Valdueza
- Neurological Centre, Segeberger Kliniken, Bad Segeberg, Germany
| | - SJ Schreiber
- Department of Neurology, University Hospital Charité, Humboldt University, Berlin
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Owen D, Paranandi B, Sivakumar R, Seevaratnam M. Classical diseases revisited: transient global amnesia. Postgrad Med J 2007; 83:236-9. [PMID: 17403949 PMCID: PMC2600033 DOI: 10.1136/pgmj.2006.052472] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Transient global amnesia usually affects patients between the ages of 40 and 80. Patients with this condition are often described--wrongly--as being confused. It presents classically with an abrupt onset of severe anterograde amnesia. It is usually accompanied by repetitive questioning. The patient does not have any focal neurological symptoms. Patients remain alert, attentive, and cognition is not impaired. However, they are disoriented to time and place. Attacks usually last for 1-8 h but should be less than 24 h. It is possible that it may result from different mechanisms such as venous congestion with valsalva-like activities before symptom onset, arterial thromboembolic ischaemia and vasoconstriction due to hyperventilation. Diagnosis may be made safely in the presence of a characteristic collateral history. No specific treatment is indicated for a typical episode.
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Affiliation(s)
- D Owen
- Department of Medicine, Queen Elizabeth II Hospital, Welwyn Garden City, Hertfordshire, UK
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Chung CP, Hsu HY, Chao AC, Sheng WY, Soong BW, Hu HH. Transient global amnesia: cerebral venous outflow impairment-insight from the abnormal flow patterns of the internal jugular vein. ULTRASOUND IN MEDICINE & BIOLOGY 2007; 33:1727-35. [PMID: 17629610 DOI: 10.1016/j.ultrasmedbio.2007.05.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2007] [Revised: 05/02/2007] [Accepted: 05/22/2007] [Indexed: 05/02/2023]
Abstract
Cerebral venous reflux is found frequently in transient global amnesia (TGA) patients. The cerebral venous reflux mostly results from left brachiocephalic venous obstruction, and the level of reflux depends on different respiratory status. For further understanding of the role of venous outflow impairment in the pathogenesis of TGA, we used color duplex sonography to reveal the flow patterns in the internal jugular vein (IJV) and its branches (JB) under different respiratory conditions. We compared the frequency of abnormal venous flow of IJV and/or JB on color duplex sonography between 17 TGA patients and 17 age- and gender-matched normal individuals both at rest (regular breathing) and at deep inspiration. Further, these venous-flow abnormalities in IJV and JB were well described. Cranial 3-D time-of-flight magnetic resonance arteriography (MRA) were performed in all patients three to seven days after their TGA attacks and in all normal individuals to analyze the abnormal flow signals in the intracranial venous structures. In the result, abnormal flow-patterns in the left IJV and/or left JB during regular breathing were found more frequently in TGA patients than normal individuals (65% vs. 6%; p < 0.001). These abnormalities in TGA patients were (1) isolated reversed flow in the left JB, (2) segmental reversed flow in the left distal IJV and (3) continuous reversed flow in the left IJV and JB. The MRA study revealed that only the most severe reflux in the IJV causes intracranial venous reflux; six were in the group of continuous reversed flow in left IJV and one was in the group of segmental reversed flow in left distal IJV. These findings suggest that TGA might be one of the clinical manifestations of the "cerebral-type intermittent venous claudication," which stems from cerebral venous outflow impairment, insufficient venous collaterals and specific precipitating factors.
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Affiliation(s)
- Chih-Ping Chung
- Section of Neurovascular Diseases, Neurological Institute, Veterans General Hospital-Taipei, Taipei, Taiwan
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Nedelmann M, Teschner D, Dieterich M. Analysis of internal jugular vein insufficiency--a comparison of two ultrasound methods. ULTRASOUND IN MEDICINE & BIOLOGY 2007; 33:857-62. [PMID: 17445963 DOI: 10.1016/j.ultrasmedbio.2007.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2006] [Revised: 11/23/2006] [Accepted: 02/14/2007] [Indexed: 05/15/2023]
Abstract
Jugular venous valve insufficiency is a contributing factor to different pathologic conditions. For assessment of insufficiency, two ultrasound techniques have been developed, that are based on very different methodology (direct Doppler assessment versus air contrast ultrasound venography [ACUV]). This study was conducted to compare these two methods to improve comparability of existing studies and diagnostic accuracy in future studies. The function of 40 valves was determined in 20 individuals during a Valsalva maneuver. For direct Doppler assessment, valvular competence was assessed on basis of Doppler recordings, following recently established criteria. Valvular insufficiency in ACUV was diagnosed when reflux of an air-based echo contrast agent through the valve could be detected. With both methods, evaluation of 39 valves was accomplished (one exclusion due to hypoplasia of the corresponding vein). Both methods showed very high agreement in detection rates. All 18 valves being classified as insufficient by Doppler criteria were also insufficient in ACUV. Of 21 valves classified as competent (Doppler), one valve was rated as insufficient in ACUV due to discrete reflux of microbubbles. However, ACUV was inaccurate in evaluation of the left internal jugular vein after injection of the contrast agent into the right cubital vein. High detection rates could only be achieved when this was taken into account. This study shows that detection rates of internal jugular valve insufficiency are very similar with both methods. However, this high agreement required modification of the established protocol of ACUV.
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Affiliation(s)
- Max Nedelmann
- Department of Neurology, Johannes Gutenberg University, Mainz, Germany.
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Bartsch T, Alfke K, Deuschl G, Jansen O. Evolution of hippocampal CA-1 diffusion lesions in transient global amnesia. Ann Neurol 2007; 62:475-80. [PMID: 17702037 DOI: 10.1002/ana.21189] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Selective focal MR-Signal (diffusion-) changes in the CA-1 sector of the hippocampus have been described in transient global amnesia (TGA), but the pathophysiological substrate of these lesions is largely unknown. As several imaging and epidemiological findings point to a vascular origin an analysis of the temporal evolution of the hippocampal apparent diffusion coefficient (ADC) changes may offer new understanding of the pathomechanisms of TGA. METHODS The time course of the ADC of hippocampal DWI lesions in TGA patients was studied using serial 3 T high-resolution MR-imaging within 1-10 days as well as 4-6 months after TGA. ADC values from 76 MR-studies were analyzed and expressed as ratio ADC (rADC) in reference to the unaffected hemisphere. RESULTS Twenty-nine patients with TGA showed 34 DWI lesions with corresponding T2 lesions in the CA-1 sector of the hippocampal cornu ammonis within a time window of 24-72 h after onset. Ratio ADC decreased below 1.0 (0.66 +/- 0.08) 24 h after the acute TGA episode and did show a further significant decrease to 0.57 +/- 0.1 after 3 days (p < 0.05). After 72 h, rADC increased and normalized around day 10 with rADC values of 1.0 (p < 0.05). INTERPRETATION The temporal evolution of the rADC in hippocampal signal changes in TGA shows a time course previously described for ischemic lesions in human stroke patients. This might imply a vascular origin of diffusion changes leading to a transient perturbation of memory relevant circuits in the hippocampus.
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Affiliation(s)
- Thorsten Bartsch
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany.
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