Reversible Cerebral Vasoconstriction Syndrome Presenting with Transient Global Amnesia

Abstract

A 65-year-old man who had been diagnosed with transient global amnesia (TGA) 15 years previously was admitted to hospital with complaints of amnesia and headache. His symptoms improved on day-2. The initial brain MRI and electroencephalography findings were normal. He was diagnosed with a recurrence of TGA and discharged. However, he returned with right leg weakness and complained of a thunderclap headache. MRI demonstrated subarachnoid hemorrhage and multifocal segmental narrowing of the left posterior cerebral artery (PCA) and large intracranial arteries, and he was diagnosed with reversible cerebral vasoconstriction syndrome (RCVS). He was discharged on day-30 without any neurological deficits. This case suggested that TGA should be interpreted as one of the symptoms of RCVS or a prodromal symptom of RCVS.

The link between reversible cerebral vasoconstriction syndrome and transient global amnesia

“…RCVS and TGA are two acute and reversible intra-cerebral conditions whose coexistence has, to our knowledge, only been reported in a total of six cases worldwide (Table 1). 1,3,6,7 We report the seventh case, linking RCVS to TGA and propose a common pathophysiologic link.…”

“…Although RCVS is a self‐limited entity, significant complications of subarachnoid hemorrhage, cerebral infarction and seizures have been reported leading to disability and poor functional outcomes 2 . According to recent literature, the frequency of TCH is the most predictive diagnostic factor for RCVS with a sensitivity and specificity of 74% and 98%, respectively 3 . Definite TGA is characterized by a sudden onset of anterograde amnesia without clouding or loss of consciousness, lack of epileptic features, head trauma and focal neurologic deficits witnessed by a reliable observer during the attack, furthermore the amnestic event must resolve within 24 h 4 .…”

“…2 According to recent literature, the frequency of TCH is the most predictive diagnostic factor for RCVS with a sensitivity and specificity of 74% and 98%, respectively. 3 rologic deficits witnessed by a reliable observer during the attack, furthermore the amnestic event must resolve within 24 h. 4 RCVS and TGA are rare disorders with an annual incidence of three and 3-10 cases per million, respectively, in the general population. 2,4 The patient described in our case was given an RCVS2 score of 8…”