Recurrent transient global amnesia as presenting symptoms of CADASIL.
Ontology highlight
ABSTRACT:
SUBMITTER: Pradotto L
PROVIDER: S-EPMC5093160 | biostudies-literature | 2016 Nov
REPOSITORIES: biostudies-literature
Publications
Recurrent transient global amnesia as presenting symptoms of CADASIL.
Pradotto Luca L Orsi Laura L Mencarelli Monica M Caglio Marcella M Lauro Danilo D Milesi Alessandra A Di Blasio Anna A Mauro Alessandro A
Clinical case reports 20160928 11
Despite transient global amnesia is considered unusual in Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) and causal relation is still unclear, this report suggests to consider CADASIL in those patients with recurrent transient global amnesia, especially when MRI shows multifocal hyperintensities affecting the cerebral white matter or when it is followed by cognitive decline. ...[more]
Similar Datasets
Project description:ImportanceTransient global amnesia (TGA) is usually considered a benign event with a low recurrence rate. However, recurrence rates vary considerably among studies and there are no known risk factors for TGA.ObjectiveTo examine risk factors for the recurrence of TGA.Design, setting, and participantsThis retrospective cohort study involved medical record review of patients with isolated or recurrent TGA presenting to the Mayo Clinic in Rochester, Minnesota, between August 1, 1992, and February 28, 2018. A total of 1491 cases were reviewed and 1044 met diagnostic inclusion criteria for TGA, with the remainder excluded owing to indeterminate or alternate diagnoses or limited information available in the medical record.ExposuresSingle vs recurrent episodes of TGA.Main outcomes and measuresDemographics, precipitating factors, migraine history, imaging and electrodiagnostic findings, and family history of TGA were collected. The main outcome measure was TGA recurrence.ResultsOf 1044 included patients, 575 (55.1%) were male, and the mean (SD) age at inclusion was 75.0 (11.5) years. A total of 901 patients (86.3%) had a single episode of TGA and 143 (13.7%) had recurrent episodes of TGA. The 2 groups were similar in age at inclusion, sex, identifiable triggers, and duration of anterograde amnesia. The number of recurrences ranged from 1 to 9, with 137 individuals (95.8%) having 3 or fewer recurrences. The mean (SD) age at first episode of TGA was 65.2 (10.0) years for individuals with a single episode vs 58.8 (10.3) years for those with recurrent episodes (P < .001). There was a personal history of migraine in 180 individuals (20.0%) with a single episode of TGA and 52 individuals (36.4%) with recurrent episodes of TGA (P < .001), and a family history of migraine in 167 individuals (18.5%) with a single episode of TGA and 44 individuals (30.8%) with recurrent episodes of TGA (P = .001). There were no electroencephalographic findings associated with increased risk of TGA recurrence. Acute and subacute temporal lobe abnormalities on results of magnetic resonance imaging were seen rarely and did not require intervention. A family history of TGA was identified in 12 individuals (1.3%) with a single episode of TGA and 4 individuals (2.8%) with recurrent episodes of TGA.Conclusions and relevanceThis study suggests that, in this large cohort of patients with TGA, recurrent TGA was associated with earlier age at the time of first TGA episode and higher prevalence of both personal and family history of migraine compared with isolated cases. These results can be used to counsel patients about risks of recurrence and may have implications for the understanding of TGA pathophysiology.
| S-EPMC7489420 | biostudies-literature
Project description:BACKGROUND:Aetiology of transient global amnesia (TGA) remains uncertain, though many have been proposed, including ischaemic, migrainous or epileptic pathologies. METHODS:We attempted to determine risk factors for TGA, as well as prognostic factors that may cause recurrence. We evaluated clinical history, family history and magnetic resonance diffusion-weighted imaging (DWI) studies of 93 prospective patients with TGA. Patients were followed from 2004 to 2016. Fifteen of 93 (16%) patients experienced a recurrence of TGA. RESULTS:Among precipitating events, physical activities inducing Valsalva-like manoeuvres were most common, followed by emotional stress. Eighty-four patients had possible comorbidities or risk factors for TGA, though no single risk factor was ubiquitous. Risk factors associated with recurrence were head injury (isolated vs. recurrent, 16.7% vs. 53.5%, p <?0.01), depression (isolated vs. recurrent, 15.4% vs 46.7%, p =?0.01) and family history of dementia (isolated vs. recurrent, 20.5% vs. 46.7%, p =?0.03). Of 15 patients with confirmed recurrent TGA, two developed dementia and four subjective memory impairment. DWI lesions were observed in 24 patients and were located anywhere within the hippocampus. CONCLUSIONS:DWI lesions were not significantly associated with outcomes (recurrence, subjective memory impairment, dementia). We have found that depression, previous head injury and family history of dementia may predict TGA recurrence.
| S-EPMC7060647 | biostudies-literature
Project description:Abnormal extracranial venous drainage modality has been considered an etiology of transient global amnesia (TGA). Evidence suggests that the transmission of the intrathoracic/intraabdominal pressure during a Valsalva maneuver (VM) is mainly through the vertebral venous system, and patency of internal jugular vein (IJV) is essential for venous drainage and pressure releasing. We hypothesize that obstruction of IJV venous drainage is a contributing factor in TGA pathogenesis. A magnetic resonance (MR) imaging protocol was used in 45 TGA patients and 45 age- and sex-matched controls to assess the morphologies of IJV, brachiocephalic vein (BCV) and asymmetry of transverse sinus (TS). The IJV was divided into the upper- and middle-IJV segments. Compared to the controls, TGA patients had significantly higher rates of moderate and severe compression/stenosis at the bilateral upper-IJV segment (left: 37.8% vs. 17.8%, P = 0.0393; right: 57.8% vs.15.6%, P<0.0012), in left BCV (60% vs. 8.9%, P<0.0004), and in TS hypoplasia (53.3%% vs. 31.1%, P = 0.0405). The prevalence of at least one site of venous compression/stenosis in IJV or BCV was significantly higher in patients than in controls (91.1% vs. 33.3%, P<0.0004). The diameter of the left TS in MRV, but not in T1 contrast imaging, was significantly smaller in TGA patients than in controls (0.31 ± 0.21 vs. 0.41 ± 0.19, P = 0.0290), which was compatible with downstream venous stenosis/obstruction. TGA patients have a higher prevalence of compression/stenosis of the bilateral IJV and the left BCV and TS hypoplasia, which is new evidence that supports the role of extracranial veins in TGA pathogenesis.
| S-EPMC4501814 | biostudies-literature
Project description:A 60-year-old woman was travelling on a plane with her spouse when she suddenly developed acute-onset disorientation to time and space. According to her husband, she repetitively questioned her whereabouts and complained of a minor headache. Upon landing, she was immediately brought to the emergency room and subsequent magnetic resonance imaging was performed, which showed multiple punctate 2-3 mm regions of diffusion-weighted imaging hyperintensity in the medial aspects of both temporal lobes. The conglomeration of clinical history and radiological findings was most suggestive of transient global amnesia. This article discussed the background, proposed mechanisms, diagnosis, radiological characteristics and management of transient global amnesia.
| S-EPMC6056376 | biostudies-literature
Project description:While the pathophysiology of transient global amnesia (TGA) is not understood, due to the specific nature of the clinical deficits, transient dysfunction in the medial temporal lobe, especially in the hippocampus, is assumed; however, concomitant disturbances in other brain regions and in executive function have been postulated. In this study, a cohort of 16 patients was prospectively recruited from the emergency department for resting-state functional MRI (fMRI) during the acute stage of TGA, as confirmed by a standardized neuropsychological assessment. Twenty age- and sex-matched controls, as well as twenty patients with a history of TGA, were recruited for comparison. Functional data were processed using independent component analysis (ICA), allowing the complete automatic (data-driven) identification of spontaneous network dynamics. We documented a severe disturbance in anterograde episodic long-term memory in all patients. Group-based ICA of resting-state data in acute TGA patients versus that of controls and patients with a past TGA episode demonstrated reduced FC mainly of structures belonging to the executive network (EN), but also the hippocampus, confirming its pathophysiological involvement in the disorder, as well as areas belonging to the salience network and other subcortical regions. No significant differences were found when comparing connectivity in patients with a history of TGA and controls. Our findings strengthen previous empirical and theoretical accounts of hippocampal and executive dysfunction in TGA. The disruption of frontal, parietal and insular control regions, together with disruption in the hippocampus, provides a new interpretation for the pathophysiology and neuropsychological profile of this neurological disorder on a large-scale network level.
| S-EPMC6543172 | biostudies-other
Project description:Acute perturbation of the hippocampus, one of the connector hubs in the brain, is a key step in the pathophysiological cascade of transient global amnesia (TGA). We tested the hypothesis that network efficiency, meaning the efficiency of information exchange over a network, is impaired during the acute stage of TGA. Graph theoretical analysis was applied to resting-state EEG data collected from 21 patients with TGA. The EEG data were obtained twice, once during the acute stage (< 24 hours after symptom onset) and once during the resolved stage (> 2 months after symptom onset) of TGA. Characteristic path lengths and clustering coefficients of functional networks constructed using phase-locking values were computed and normalized as a function of the degree in the delta, theta, alpha, beta 1, beta 2 and gamma frequency bands of the EEG. We investigated whether the normalized characteristic path length (nCPL) and normalized clustering coefficients (nCC) differed significantly between the acute and resolved stages of TGA at each frequency band using the Wilcoxon signed-rank test. For networks where the nCPL or nCC differed significantly between the two stages, we also evaluated changes in the connections of the brain networks. During the acute stage of TGA, the nCPL of the theta band networks with mean degrees of 8, 8.5, 9 and 9.5 significantly increased (P < 0.05). During the acute stage, the lost edges for these networks were mostly found between the anterior (frontal and anterior temporal) and posterior (parieto-occipital and posterior temporal) brain regions, whereas newly developed edges were primarily found between the left and right frontotemporal regions. The nCC of the theta band with a mean degree of 5.5 significantly decreased during the acute stage (P < 0.05). Our results indicate that TGA deteriorates the network efficiency of the theta frequency band. This effect might be related to the desynchronization between the anterior and posterior brain areas.
| S-EPMC5065218 | biostudies-literature
Project description: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.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.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.
| S-EPMC5889575 | biostudies-literature
Project description: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.
| S-EPMC6370701 | biostudies-literature
Project description:Psychological stress has been associated with transient global amnesia (TGA). Whether a cancer diagnosis, a severely stressful life event, is associated with subsequent risk of TGA has not been studied.Based on the Swedish Cancer Register and Patient Register, we conducted a prospective cohort study including 5,365,608 Swedes at age 30 and above during 2001-2009 to examine the relative risk of TGA among cancer patients, as compared to cancer-free individuals. Incidence rate ratios (IRRs) and their 95% confidence intervals (CIs) derived from Poisson regression were used as estimates of the association between cancer diagnosis and the risk of TGA.During the study 322,558 individuals (6.01%) received a first diagnosis of cancer. We identified 210 cases of TGA among the cancer patients (incidence rate, 0.22 per 1000 person-years) and 4,887 TGA cases among the cancer-free individuals (incidence rate, 0.12 per 1000 person-years). Overall, after adjustment for age, sex, calendar year, socioeconomic status, education and civil status, cancer patients had no increased risk of TGA than the cancer-free individuals (IRR, 0.99; 95% CI, 0.86-1.13). The IRRs did not differ over time since cancer diagnosis or across individual cancer types. The null association was neither modified by sex, calendar period or age.Our study did not provide support for the hypothesis that patients with a new diagnosis of cancer display a higher risk of TGA than cancer-free individuals.
| S-EPMC4388478 | biostudies-other
Project description:Transient epileptic amnesia (TEA) is a rare epileptic condition, often confused with transient global amnesia (TGA). In a real-life scenario, differential diagnosis between these two conditions can be hard. In this study we use power spectral analysis empowered by exact Low Resolution Brain Electromagnetic Tomography (eLORETA) to evidence the differences between TEA and TGA. Fifteen patients affected by TEA (64.2 ± 5.2 y.o.; 11 female/4 male; 10 left and 5 right temporal epileptic focus) and 15 patients affected by TGA (65.8 ± 7.2 y.o.; 11 females/4 males) were retrospectively identified in our clinical records. All patients recorded EEGs after symptoms offset. EEGs were analyzed with eLORETA to evidence power spectral contrast between the two conditions. We used an inverse problem solution to localize the source of spectral differences. We found a significant increase in beta band power over the affected hemisphere of TEA patients. Significant results corresponded to the uncus and para-hippocampal gyrus, respectively Brodmann's Areas: 36, 35, 28, 34. We present original evidence of an increase in beta power in the affected hemisphere (AH) of TEA as compared to TGA. These differences involve key areas of the memory network located in the mesial temporal lobe. Spectral asymmetries could be used in the future to recognize cases of amnesia with a high risk of epilepsy.
| S-EPMC7563784 | biostudies-literature