Cerebrovascular Risk Factors and Triggers in Transient Global Amnesia Patients with and without Jugular Valve Incompetence: Results from a Sample of 243 Patients

Abstract

Background/Aims: Different etiologies for transient global amnesia (TGA) have been proposed, such as venous flow abnormalities, spreading depression and migraine-related mechanisms like focal ischemia. Jugular vein valve incompetence (JVI) is commonly described in TGA patients, but its contributing role in TGA pathogenesis is still unknown. We investigated the possible relationship between JVI and pathogenetic mechanisms in TGA. Methods: 243 TGA patients underwent clinical and neurological assessment. Demographic characteristics, TGA-precipitating factors and vascular comorbidities were carefully recorded. In each patient, JVI was assessed by Doppler ultrasonography. Results: TGA patients were grouped according to the presence (n = 171, 70.4%) or absence (n = 72, 29.6%) of JVI. TGA patients with JVI showed a higher presence of precipitating factors, namely a Valsalva-like maneuver (JVI-positive vs. JVI-negative, 35.8 vs. 17.1%, p = 0.004) and emotional stress (36.6 vs. 21.4%, p = 0.023), but had fewer vascular comorbidities, namely hypertension (37.2 vs. 51.4%, p = 0.047) and carotid arteriosclerosis (20.5 vs. 31.9%, p = 0.050). Conclusions: These findings support the argument for the existence of at least 2 different TGA-associated mechanisms defined by JVI. On the one hand, JVI associated with a Valsalva-like maneuver and emotional stress supported the venous blood congestion hypothesis, and on the other, the JVI-negative group may have another vascular basis, unrelated to venous congestion.

Transient Global Amnesia: Seven Years of Experience with Diffusion-Weighted Imaging in an Emergency Department

“…An animal study indicated that acute emotional and behavioral stress impaired long-term potentiation and increased long-term depression in CA1 neurons, and also disrupted hippocampus-dependent memory [23]. Recent research has suggested that one of the main pathogenic mechanisms of TGA is jugular valve incompetence, leading to venous congestion, ischemia, and vasogenic edema, but this proposal remains controversial [14,24]. At present, several hypotheses remain possible and no unequivocal evidence indicates that hippocampal lesions cause TGA.…”

Different Risk Factor Profiles between Transient Global Amnesia and Transient Ischemic Attack: A Large Case-Control Study

“…Among them, cerebral ischemia in terms of thromboembolic etiology or hemodynamics was investigated through several case-control studies in comparison with transient ischemic attack (TIA), but did not find an association between TGA and cardiovascular risk factors [6,7,8,9,10,11]. Those studies focused on arterial ischemia considering an abrupt onset of TGA or an MRI finding, but recent studies are in search of venous congestion with subsequent ischemia combined with jugular valve insufficiency [4,12,13,14,15,16]. However, the question still remains whether cardiovascular risk factors are related to the occurrence of TGA at all.…”

Incidence of Extrinsic Compression of the Internal Jugular Vein in Unselected Patients Undergoing CT Angiography

“…Recent literature has suggested that restriction of extracranial venous drainage may be a risk factor in the development of MS. [1][2][3] Published series of treatment with angioplasty and/or stent placement have begun to emerge based on this yet unproved hypothesis. 4,5 Jugular venous pathology has also been linked with transient global amnesia 6,7 and migraines, [8][9][10][11] though this is controversial 11 and no clear etiologic link to venous pathology has been established for either disease.…”