Transient Topographical Disorientation

Abstract

Transient topographical disorientation (TTD) is a short-lasting inability to find one’s way in a familiar environment, while the patient remains conscious and is able to recall what happened. We report the study of 10 patients with episodes of TTD, studied on the days following the last episode. The episodes of TTD could be separated into two types: the patients either reported difficulties in spatial orientation with preserved abilities to recognize landmarks and objects, or the difficulties appeared with the recognition of landmarks. Tests exploring spatial orientation, as well as higher visuoperceptive capacities were altered in most of the patients and brain SPECT showed hypoperfusion of the right hemisphere in all patients, which could also be demonstrated 2 years later in some cases. Altogether, our findings suggest that TTD is frequently associated with a more persistent right hemisphere dysfunction of unknown cause. This chronic alteration could represent either a sequel of the acute episode or a preexisting right hemisphere deficit, which inclined the acute insult to be manifested as TTD.

Transient Directional Disorientation as a Manifestation of Cerebral Ischemia

“…Recently, cases of TDD of unknown etiology have been reported [10, 11], and some of them were considered to be an epileptic manifestation [10], but vascular origin was not suggested for these cases. Our patients had vascular risk factors such as diabetes (case 1), hypertension (case 2), and atrial fibrillation (case 2).…”

Recurrent transient topographical amnesia: a patient with frequent episodes

“…The selective deficit of topographical disorientation is relatively rare and has been attributed to cerebrovascular disease, Alzheimer's disease, and frontotemporal dementia [1][2][3]. Recently, cases of transient topographical amnesia (TTA) have been published [4][5][6][7]. These cases are characterized by a sudden onset and short-lasting disturbance in orientation without any loss of consciousness or episodic memory.…”

“…Transient topographical amnesia is a rare symptom, and previous literature reported that some episodes are caused by transient ischemic attack [8], migraine [9], normal pressure hydrocephalus [10], and epilepsy [7,11]. The etiology of TTA remains unknown.…”

“…Most patients with TTA are healthy middle-aged or elderly people, and experience attacks at most 3-5 times during their lifetime [4][5][6][7]. One report described that SPECT showed hypoperfusion of the right hemisphere in patients with TTA [7], but other report said that the SPECT finding was not subsequently confirmed [6]. TTA usually has a good outcome [5], but in a report 2 patients with TTA showed remittance with a high frequency [7].…”

Transient topographical disorientation due to right‐sided hippocampal hemorrhage

“…Functional compensation of topographical disorientation in H.W. was rapid and complete, as reported in similar previous cases (Gil‐Néciga et al., 2002; Rivest, Svoboda, McCarthy, & Moscovitch, 2018). The complete recovery of an allocentric navigation strategy despite a residual hippocampal lesion in follow‐up MRI illustrates the great plasticity of the human navigation network (Byrne et al., 2007; Ekstrom et al., 2014).…”