Transient global amnesia with unexpected clinical and radiological findings: A case series and systematic review

Piffer, Silvio; Nannoni, Stefania; Maulucci, Francesco; Beaud, Valérie; Rouaud, Olivier; Förster, Alex; Cereda, Carlo; Maeder, Philippe; Michel, Patrik

doi:10.1016/j.jns.2022.120349

Cited by 12 publications

(5 citation statements)

References 28 publications

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“…2 It is crucial to note that these acute hippocampal DWI lesions in TGA, like the condition itself, are considered to be transient in nature and are believed to "vanish" on imaging performed more than 30 days after the onset of TGA. 11 This apparent resolution of imaging findings aligns well with the conventionally held view that TGA has no long-term cognitive consequences. 12 However, more recent studies have challenged this belief.…”

Section: Discussionsupporting

confidence: 79%

Chronic hippocampal subfield damage in transient global amnesia revealed by 7T MRI: All is not reversible?

et al. 2023

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Transient global amnesia (TGA) is a neurological condition characterized by temporary memory loss and classically associated with a reversible unilateral punctate focus of restricted diffusion in the cornu ammonis 1 (CA1) region of the hippocampus. Historically, the lesions were considered to be transient in nature with no long-term imaging abnormality. However, more recent studies have challenged the concept that there are no long-term neurological sequelae. In line with this evidence, we explore the role of ultra-high-resolution imaging using 7 Tesla MRI to evaluate for long-term imaging abnormalities in a 63-year-old woman with a typical clinical course and acute TGA imaging findings. The 7 Tesla MRI revealed a residual lesion on susceptibility-weighted imaging (SWI) with evidence of gliosis and volume loss at the site of the acute lesion in CA1 eight months after the acute episode. This case challenges the traditional mantra of TGA as a fully reversible condition with no long-term imaging findings, suggesting the need for further research using ultra-high-field MRI to determine TGA's potential long-term imaging sequelae and any association with neurocognitive sequelae.

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Section: Discussionsupporting

confidence: 79%

Chronic hippocampal subfield damage in transient global amnesia revealed by 7T MRI: All is not reversible?

et al. 2023

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“…Accepted criteria define that amnesia cannot last longer than 24 hours (see the Hodges and Warlow criteria, Box 1),17 and hence our case has been labelled as a ‘TGA-like syndrome’. Other ‘atypical TGA’ cases have been described previously, including the involvement of sensorimotor deficits and prolonged amnestic periods beyond 24 hours 18. The cause of TGA is not understood and multiple proposed aetiologies have been suggested ranging from vascular to migrainous mechanisms,16 which may also encompass atypical TGA cases within a potentially broader clinical spectrum.…”

Section: Discussionmentioning

confidence: 95%

Case of transient global amnesia-like syndrome after recreational cold-water swimming

2023

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We document a case of a transient global amnesia (TGA)-like syndrome following open water swimming. This case was atypical for TGA, in that symptoms were prolonged and ischaemic infarct was considered within the differential. MRI did not demonstrate any changes associated with acute ischaemia although did show a mild degree of small vessel change. With amnesia taking greater than 24 hours to resolve, we have labelled this case to be a TGA-like syndrome, provoked by the commonly reported TGA precipitant of cold water immersion. The possibility of a tiny, strategic infarct causing these symptoms was considered and antiplatelet therapy commenced.

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“…Regarding clinical presentation of our TGA cohort, some patients reported some atypical findings, that is hemianopsia and MDwCA. In the literature, TGA patients with atypical clinical presentation have been described (the so-called “TGA-plus syndrome”) [ 39 ]. Our small group of patients with “TGA-plus syndrome” has been confirmed to be affected by TGA, since at follow-up their EEGs were devoid of IEAs and they did not report other amnesia episodes.…”

Section: Discussionmentioning

confidence: 99%

EPIAMNE: A New Scoring System for Differentiating Transient EPIleptic AMNEsia from Transient Global Amnesia

et al. 2022

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Transient epileptic amnesia (TEA) is a rare cause of acute amnestic syndromes (AAS), often misdiagnosed as transient global amnesia (TGA). We proposed a scoring system—the EPIlepsy AMNEsia (EPIAMNE) score—using quantitative EEG (qEEG) analysis to obtain a tool for differentiating TEA from TGA. We retrospectively reviewed clinical information and standard EEGs (stEEG) of 19 patients with TEA and 21 with TGA. We computed and compared Power Spectral Density, demonstrating an increased relative theta power in TGA. We subsequently incorporated qEEG features in EPIAMNE score, together with clinical and stEEG features. ROC curve models and pairwise ROC curve comparison were used to evaluate and compare the diagnostic accuracy for TEA detection of EPIAMNE score, presence of symptoms atypical for TGA (pSymAT) and identification of anomalies (interictal epileptiform or temporal focal spiky transients) at stEEG (PosEEG). Area Under the Curve (AUC) of EPIAMNE score revealed to be higher than PosEEG and pSymAT (AUCEPIAMNE = 0.95, AUCpSymAT = 0.85, AUCPosEEG = 0.67) and this superiority proved to be statistically significant (p-valueEPIAMNE-PosEEG and p-valueEPIAMNE-pSymAT < 0.05). In conclusion, EPIAMNE score classified TEA with higher accuracy than PosEEG and pSymAT. This approach could become a promising tool for the differential diagnosis of AAS, especially for early TEA detection.

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Transient global amnesia with unexpected clinical and radiological findings: A case series and systematic review

Cited by 12 publications

References 28 publications

Chronic hippocampal subfield damage in transient global amnesia revealed by 7T MRI: All is not reversible?

Chronic hippocampal subfield damage in transient global amnesia revealed by 7T MRI: All is not reversible?

Case of transient global amnesia-like syndrome after recreational cold-water swimming

EPIAMNE: A New Scoring System for Differentiating Transient EPIleptic AMNEsia from Transient Global Amnesia

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