Transient Global Amnesia (TGA): Influence of Acute Hypertension in Patients Not Adapted to Chronic Hypertension

Abstract

Objective: Transient global amnesia (TGA) is defined by an acute memory disturbance of unclear etiology for a period of <24 h. Several studies showed differences in vascular risk factors between TGA compared to transient ischemic attack (TIA) or healthy controls with varying results. This retrospective and cross-sectional study compares the cardiovascular risk profile of TGA patients with that of acute stroke patients.Methods: Cardiovascular risk profile and MR imaging of 277 TGA patients was retrospectively analyzed and compared to 216 acute ischemic stroke patients (26% TIA).Results: TGA patients were significantly younger and predominantly female compared to stroke patients. A total of 90.6% of TGA patients underwent MRI, and 53% of those showed hippocampal diffusion-weighted imaging (DWI) lesions. Scores for cerebral microangiopathy were lower in TGA patients compared to stroke patients. After statistical correction for age, TGA patients had higher systolic and diastolic blood pressure, higher cholesterol levels, lower HbA1c, as well as blood glucose levels, and lower CHA2DS2-VASc scores. Stroke patients initially displayed higher CRP levels than TIA and TGA patients. TGA patients without DWI lesions were older and showed higher CHA2DS2-VASc scores compared to TGA patients with DWI lesions.Conclusion: This study revealed significant differences between TGA and stroke patients in regard to the cardiovascular risk profile. Our main findings show a strong association between acute hypertensive peaks and TGA in patients not adapted to chronic hypertension, indicating a vascular cause of the disease.

Transient Global Amnesia (TGA): Younger Age and Absence of Cerebral Microangiopathy Are Potentially Predisposing Factors for TGA Recurrence

“…A recent study by our group showed an association between acute hypertension and TGA occurrence ( 10 ). Herein, TGA patients were less likely to suffer from chronic hypertension compared to acute stroke patients.…”

“…These observations are substantiated by evidence of a lower vascular mortality risk in TGA patients compared with TIA patients ( 11 ). It was hypothesized that acute hypertensive peaks may trigger TGA episodes, especially in patients who are not adapted to chronic hypertension ( 10 ). These observations are well in line with our current results.…”

“…Patients who did not meet the diagnostic criteria were not included in the study. This study is an extension of the cohort from a previously reported study ( 10 ). Patients treated in 2011, 2012 and 2020 were added so that a full decade could be analyzed.…”

“…In contrast, absolute blood pressure values on admission were higher in TGA patients compared with acute stroke patients (10). Based on these findings, it has been hypothesized that failure of cerebrovascular autoregulation (autoregulatory breakdown) and subsequent hypertensive encephalopathy may play a role in the development of TGA, which may occur at lower blood pressure levels in patients unaccustomed to chronic hypertension (10).…”

“…In a recent study, an association was reported between acute hypertension in patients not adapted to chronic hypertension and the occurrence of TGA ( 10 ). TGA patients showed a lower extent of cerebral microangiopathy and less frequent septal hypertrophy in transthoracic echocardiography compared with stroke patients, thus presenting less sequelae of hypertensive heart and brain damage.…”