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Schütz E, Altenmüller D, Wagner K, Heers M, Schulze‐Bonhage A, Metternich B. Transient global amnesia after the right temporal epilepsy surgery: A case report. Epilepsia Open 2024; 9:1948-1955. [PMID: 38970777 PMCID: PMC11450605 DOI: 10.1002/epi4.13009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 06/03/2024] [Accepted: 06/20/2024] [Indexed: 07/08/2024] Open
Abstract
Transient global amnesia (TGA) is characterized by sudden and temporary memory impairment, while transient epileptic amnesia (TEA) represents amnestic attacks as the main manifestation of focal epilepsy with presumed temporal origin. We present a 48-year-old patient who experienced transient amnesia 10 weeks after right selective amygdalo-hippocampectomy for right temporal lobe epilepsy. Despite TEA being a plausible explanation for amnesia in patients with temporal lobe epilepsy, no epileptiform discharges were found during the amnestic episode and key features indicative of TGA, including long duration, isolated occurrence, and dense anterograde amnesia of the episode, argued against a diagnosis of TEA in this case. Notably, the patient has remained seizure-free (now 4,5 years) and stopped taking antiseizure medication 32 months after surgery. Although TGA clinical criteria formally exclude patients with recent active epilepsy, neurologists should be aware that TGA can occur after epilepsy surgery in the temporal lobe. Therefore, we consider it of high clinical relevance to establish a careful differential diagnosis between TGA and epileptic amnestic attacks after epilepsy surgery to avoid unnecessary reintroduction or continuation of antiseizure medication. Additionally, this case presents the first comparison of detailed neuropsychological test results before and after a presumed TGA episode, revealing a complete recovery of anterograde memory functions within 1 day. PLAIN LANGUAGE SUMMARY: A 48-year-old patient experienced an episode of transient amnesia 10 weeks after epilepsy surgery. Given the patient's history, an epileptic origin of the episode initially seemed likely. However, tests revealed no seizure activity during the episode and the characteristics matched a condition called transient global amnesia. This case highlights the importance of correctly diagnosing memory impairments after epilepsy surgery to prevent unnecessary treatment.
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Affiliation(s)
- Elisa Schütz
- Epilepsy Center, Department for Neurosurgery, Medical CenterUniversity of FreiburgFreiburgGermany
| | | | - Kathrin Wagner
- Epilepsy Center, Department for Neurosurgery, Medical CenterUniversity of FreiburgFreiburgGermany
| | - Marcel Heers
- Epilepsy Center, Department for Neurosurgery, Medical CenterUniversity of FreiburgFreiburgGermany
| | - Andreas Schulze‐Bonhage
- Epilepsy Center, Department for Neurosurgery, Medical CenterUniversity of FreiburgFreiburgGermany
| | - Birgitta Metternich
- Epilepsy Center, Department for Neurosurgery, Medical CenterUniversity of FreiburgFreiburgGermany
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Mahmoudi Z, Tajik A, Vahdat M, Mobarakeh KA, Saeedirad Z, Azaryan F, Amjadi A, Alami F, Valisoltani N, Mirshafaei MA, Khoshdooz S, Gholamalizadeh M, Doaei S, Kooshki A. The association between dietary intake of fats and transient global amnesia (TGA). Nutr Neurosci 2024:1-7. [PMID: 39012761 DOI: 10.1080/1028415x.2024.2359866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
BACKGROUND Different types of dietary fat may influence memory and cognitive functions. This study aimed to investigate the association between dietary fat intake and transient global amnesia (TGA). METHODS This case-control study was conducted using Persian Sabzevar cohort data on 258 individuals with TGA and 520 individuals without amnesia in Sabzevar Iran. The food frequency questionnaire (FFQ) was used to assess the intake of dietary fats of the participants. All study participants were screened for TGA by a neurologist and their status was determined based on the diagnostic symptoms defined by the Kaplan and Hodges criteria. RESULTS There was an inverse association between the risk of TGA and dietary intake of alpha-linolenic acid (ALA) (OR = 0.94, CI95%:0.88-0.99, P = 0.01). Also, a positive association was observed between TGA and dietary intake of n-6 fatty acids (OR = 1.18, CI 95%: 1.04-1.33, P = 0.01). The results remained significant after adjustment for age, sex, education, job, marital status, physical activity, BMI, and calorie intake. CONCLUSION Omega-3 fatty acids may have beneficial effects; however, omega-6 fatty acids may have adverse effects on the risk of amnesia. Further longitudinal studies are warranted.
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Affiliation(s)
- Zahra Mahmoudi
- Department of Nutrition, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Ali Tajik
- University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mahsa Vahdat
- Department of Nutrition, School of Paramedicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Khadijeh Abbasi Mobarakeh
- Nutrition and Food Security Research Center, Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Saeedirad
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Azaryan
- Department of Physiology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Arezoo Amjadi
- Department of Nutrition, School of Nutritional Sciences and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Farkhondeh Alami
- Student Research Committee, Department of Nutrition, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Neda Valisoltani
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoomeh Alsadat Mirshafaei
- Department of Physical Education and Sport Sciences, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran
| | - Sara Khoshdooz
- Faculty of Medicine, Guilan University of Medical Science, Rasht, Iran
| | - Maryam Gholamalizadeh
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeid Doaei
- Department of Community Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Akram Kooshki
- Non-Communicable Diseases Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
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Martins I, Araújo T, Madeira I, Ribeiro JF, Fernandes A. A Dive Into Oblivion: A Case of Transient Global Amnesia. Cureus 2024; 16:e59603. [PMID: 38826884 PMCID: PMC11144453 DOI: 10.7759/cureus.59603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2024] [Indexed: 06/04/2024] Open
Abstract
Transient global amnesia (TGA) is an uncommon neurologic disorder that consists of a sudden and temporary loss of memory, both present and past. Its causes and risk factors are not well known. We describe a case of a 58-year-old woman who was brought to the emergency department (ED) with sudden onset loss of memory and disorientation after a dive in the ocean. She presented memory deficits with incapacity to retain new memories and amnesia for the previous 24 hours. All exams ordered were normal, including computed tomography of the brain and laboratory analysis. After six hours of close monitoring in the ED, she gradually started to retain short-term memories and was discharged after 48 hours with no memory or other deficits. The diagnosis of TGA was made based on the clinical presentation and the patient's rapid improvement. Follow-up neurology consultation and further testing did not demonstrate any evidence to exclude this diagnosis. Further research is needed on this topic to allow the identification of risk factors and causes to prevent it.
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Affiliation(s)
- Inês Martins
- Department of Critical Care Medicine, Unidade Local de Saúde do Litoral Alentejano, EPE, Santiago do Cacém, PRT
| | - Tiago Araújo
- Department of Critical Care Medicine, Unidade Local de Saúde do Litoral Alentejano, EPE, Santiago do Cacém, PRT
| | - Inês Madeira
- Department of Critical Care Medicine, Unidade Local de Saúde do Litoral Alentejano, EPE, Santiago do Cacém, PRT
| | - João Frederico Ribeiro
- Department of Critical Care Medicine, Unidade Local de Saúde do Litoral Alentejano, EPE, Santiago do Cacém, PRT
| | - Ana Fernandes
- Department of Critical Care Medicine, Unidade Local de Saúde do Litoral Alentejano, EPE, Santiago do Cacém, PRT
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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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Ramos GB, Lopes CCB, Comerlatti LR, Studart-Neto A, Silva GD. Letter to the Editor: Is it time to expand the clinical spectrum of transient global amnesia? J Neurol Sci 2022; 442:120449. [PMID: 36272269 DOI: 10.1016/j.jns.2022.120449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 10/01/2022] [Indexed: 11/25/2022]
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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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