Letter by Griebe et al Regarding Article, “Jugular Veins in Transient Global Amnesia: Innocent Bystanders”

Griebe, Martin; Hennerici, Michael G.; Szabo, Kristina

doi:10.1161/strokeaha.112.672733

Cited by 3 publications

(2 citation statements)

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“…From the patient with corticosteroid-induced delirium and the patient with amlodipine intoxication, we learn that it is always mandatory to reconstruct the “complete history” of every (suspected) TGA, including a detailed third-party anamnesis and an assessment of all context factors. High glucocorticoid levels are known to increase the neuronal vulnerability of the hippocampus and decrease the blood flow in the mesial temporal lobe and to have a negative effect on cognition and memory [24, 25]. Probably, these effects led to the manifestation of the amnestic episode.…”

Section: Resultsmentioning

confidence: 99%

Prevalence of Mimics and Severe Comorbidity in Patients with Clinically Suspected Transient Global Amnesia

Werner

Woehrle

2021

Cerebrovasc Dis

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Background: Transient global amnesia (TGA) is a syndrome featuring acute anterograde amnesia as the most striking clinical symptom. Its etiology is still a matter of debate. Most neurological guidelines allow the diagnosis on the basis of clinical criteria only; a more extensive evaluation is recommended only for patients with “red flags” like severe headache, nausea or vomiting, or metabolic abnormalities. The aim of our study was to assess the frequency of a severe underlying disease or alternative diagnoses (mimics) in patients fulfilling the clinical criteria. Methods: We evaluated the medical records and the imaging data of an unselected consecutive cohort of patients with suspected TGA over a 7-year period. All patients were hospitalized and received a neurological workup including brain imaging, color-coded duplex sonography of the brain supplying arteries, electroencephalography, and laboratory studies of blood and (in selected cases) cerebrospinal fluid. Results: 163 patients with 166 episodes of suspected TGA were hospitalized (3 patients twice). After the workup, the diagnosis of TGA was confirmed in 148/166 (89.2%) episodes (“simple TGA”). Eighteen patients (10.8%) either had an alternative diagnosis or a severe comorbidity that was assumed to have had an impact on the occurrence of the amnestic episode (“complicated TGA/mimic”). The most important differential diagnosis was stroke (11 patients, 6.6% of all TGA suspects and 61.1% of the complicated TGA/mimic group). Other mimics were transient epileptic amnesia (2 patients) and steroid-induced delirium (1 patient). Important comorbidities that had not been obvious at the time of presentation were severe sleep apnea (2 patients), triptan overuse (1 patient), and an involuntary amlodipine intoxication during TGA. Conclusion: As approximately every tenth patient with suspected TGA either had an alternative diagnosis or a severe comorbidity, which had not been obvious at the time of admission, we consider in-patient treatment of all suspected TGA cases as appropriate, preferably in the setting of a stroke unit, as ischemic stroke was the by far most important diagnosis mimicking TGA.

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Section: Resultsmentioning

confidence: 99%

Prevalence of Mimics and Severe Comorbidity in Patients with Clinically Suspected Transient Global Amnesia

Werner

Woehrle

2021

Cerebrovasc Dis

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“…High glucocorticoid levels in turn have been shown to increase neuronal vulnerability in the hippocampus, induce a decrease in regional cerebral blood flow in the mesial temporal lobe, and have a negative effect on cognition and memory [42]. To test this assumption, an ongoing study is examining the effect of experimental exposure to stress on stress hormone levels and hippocampal activation patterns using functional MRI in TGA patients [43]. …”

Section: Etiological Considerationsmentioning

confidence: 99%

Transient Global Amnesia

Szabo

2014

Frontiers of Neurology and Neuroscience

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Transient global amnesia in legal proceedings

et al. 2014

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Transient global amnesia (TGA) is a neurological disorder characterized by an acute onset of severe anterograde amnesia. While retrograde amnesia may be present-although to a lesser extent-patients have no further cognitive disturbances or neurological signs. These symptoms resolve fully within several hours leaving a permanent memory gap for the duration of the episode and do not lead to long-term neurological deficits. In addition to well-defined clinical diagnostic criteria, in up to 80 % of patients, small, point-shaped lesions in the hippocampus are detected 24-48 h after symptom onset on diffusion-weighted magnetic resonance images. Despite several etiological hypotheses, to date, there is no scientific proof for the etiology of TGA or the small hippocampal lesions. Interestingly, in a large number of cases, an emotionally or physically straining event precipitates the onset of TGA, suggesting a stress-related mechanism. We report two cases of TGA occurring in legally relevant settings: affecting the victim of brutal burglary and the key witness in a murder trial. In the context of forensic medicine, the knowledge of this disorder and recognition of its typical features are essential.

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Letter by Griebe et al Regarding Article, “Jugular Veins in Transient Global Amnesia: Innocent Bystanders”

Cited by 3 publications

References 5 publications

Prevalence of Mimics and Severe Comorbidity in Patients with Clinically Suspected Transient Global Amnesia

Prevalence of Mimics and Severe Comorbidity in Patients with Clinically Suspected Transient Global Amnesia

Transient Global Amnesia

Transient global amnesia in legal proceedings

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