Transient global amnesia following transoesophageal echocardiography

Transient global amnesia (TGA) is characterised by the sudden onset of isolated anterograde amnesia, which resolves within 24 hours. Here, we discuss the case of a 63-year-old woman who underwent a transoesophageal echocardiogram (TOE) as part of her workup for pulmonary hypertension. She was well on the morning of the procedure, and following consent, underwent transoesophageal echocardiography without sedation. The procedure was uncomplicated with normal observations throughout, confirming a suspected secundum atrial septal defect. Immediately following oesophageal extubation, it was noted that the patient was disoriented. The physical neurological examination was unremarkable. Urgent MRI of the brain showed normal anatomy; a diagnosis of TGA was made. Within 10 hours of onset, the patient was back to her baseline. Isolated anterograde amnesia following transoesophageal echocardiography should raise the clinical suspicion of TGA. Prompt clinical examination and support from other specialties are paramount in making the right diagnosis.

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Is Transient Global Amnesia a Network Disease?

European Neurology ◽

10.1159/000496511 ◽

2018 ◽

Vol 80 (5-6) ◽

pp. 345-354 ◽

Cited By ~ 2

Author(s):

Kang Min Park ◽

Byung In Lee ◽

Sung Eun Kim

Keyword(s):

White Matter ◽

Healthy Subjects ◽

Transient Global Amnesia ◽

Brain Network ◽

Network Measures ◽

Postcentral Gyrus ◽

Frontal Operculum ◽

Global Amnesia ◽

The Right ◽

The Brain

Background: We evaluated a brain network using graph theoretical analysis and microstructural abnormalities of the white matter in patients with transient global amnesia (TGA). Methods: Twenty patients with TGA and healthy control subjects were recruited, and they underwent diffusion tensor imaging (DTI) scans. Graph theory was applied to obtain network measures based on DTI data. We investigated the network measures and microstructural abnormalities of white matter using tract-based spatial statistics (TBSS) analysis in the patients with TGA. Results: Measures of global topology were not different between the patients with TGA and healthy subjects. However, there were significant differences of hubs organization; the strength of the right superior and inferior orbitofrontal, the right inferior frontal operculum, the left superior parietal, and left postcentral gyrus, the cluster coefficient of the right middle orbitofrontal and left inferior parietal gyrus, the betweenness centrality of the left angular gyrus, and the pagerank centrality of the right superior and inferior orbitofrontal, right inferior frontal operculum, left superior parietal, and left postcentral gyrus in the patients with TGA were significantly lower than those in healthy subjects. Regarding the analysis of the white matter microstructure with TBSS, there were no differences in the fractional anisotropy and mean diffusivity values between the 2 groups. Conclusions: We newly identify a reorganization of network hubs of the brain network in patients with TGA, especially in the regions of the default-mode network. These alterations of the brain network may play a role in the pathophysiologic mechanism underlying TGA and suggest that TGA is a network disease.

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097 A rare case of recurrent transient global amnesia

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2018-anzan.96 ◽

2018 ◽

Vol 89 (6) ◽

pp. A38.3-A39

Author(s):

Sameer Saleem ◽

Ronak Patel ◽

Yash Gawarikar

Keyword(s):

Transient Global Amnesia ◽

Anterograde Amnesia ◽

Epileptic Activity ◽

Sudden Onset ◽

Clinical Syndrome ◽

Slice Thickness ◽

Diagnostic Dilemma ◽

Monthly Basis ◽

Neurology Clinic ◽

Global Amnesia

IntroductionTransient global amnesia (TGA) is a clinical syndrome characterised by the sudden onset of anterograde amnesia accompanied by repetitive questioning, sometimes with a retrograde component, lasting up to 24 hours, without compromise of other neurologic functions.CaseA 71 year old male presented to the neurology clinic with history of recurrent episodes of reversible anterograde amnesia with repetitive questioning. His first two episodes were in May 2016 and clinically very typical of TGA. After that he had recurrent episodes and he noted that they were happening on a monthly basis. He had an episode on 24 March 2017 at Yangon airport as he was returning from a trip to Myanmar. He had had three episodes in February 2017 and two in March and April 2017 and one episode on 20 May 2017. Initial MRI brain showed frontotemporal atrophy suggestive of Alzheimer’s disease and there was hypo-perfusion on the nuclear medicine study. EEG did not show any epileptic activity. His partner described a typical episode where the patient lost his memory for the preceding 24 hours and he had repetitive questioning such as ”what day is it” repeatedly. During the entire episode, he was conscious and able to converse appropriately. He had another episode of amnesia on 19 August and was admitted and underwent an MRI of brain, which showed characteristic punctate abnormalities in the bilateral hippocampi on B2000 DWI.ConclusionThe estimated annual rate of recurrence of TGA is 5.8%. Diagnosis is made from typical clinical features and typical MRI DWI findings of punctate lesions in the hippocampal with a DWI resolution of B=2000, and a thin slice thickness of 2 to 3 mm. Our patient had 11 documented episodes of transient amnesia and was a diagnostic dilemma until the characteristic hippocampal abnormalities were demonstrated on MRI.

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Transient global amnesia and functional retrograde amnesia: contrasting examples of episodic memory loss

Philosophical Transactions of the Royal Society B Biological Sciences ◽

10.1098/rstb.1997.0157 ◽

1997 ◽

Vol 352 (1362) ◽

pp. 1747-1754 ◽

Cited By ~ 30

Author(s):

◽

Mark Kritchevsky ◽

Joyce Zouzounis ◽

Larry R. Squire

Keyword(s):

Retrograde Amnesia ◽

Clinical Picture ◽

Memory Loss ◽

Transient Global Amnesia ◽

Anterograde Amnesia ◽

Sudden Onset ◽

Memory Problems ◽

Essentially Normal ◽

Amnesic Syndrome ◽

Global Amnesia

We studied 11 patients with transient global amnesia (TGA) and 10 patients with functional retrograde amnesia (FRA). Patients with TGA had a uniform clinical picture: a severe, relatively isolated amnesic syndrome that started suddenly, persisted for 4−12 h, and then gradually improved to essentially normal over the next 12−24 h. During the episode, the patients had severe anterograde amnesia for verbal and non-verbal material and retrograde amnesia that typically covered at least two decades. Thirty hours to 42 days after the episode, the patients had recovered completely and performed normally on tests of anterograde and retrograde amnesia. By contrast, patients with FRA had a sudden onset of memory problems that were characterized by severe retrograde amnesia without associated anterograde amnesia and with a clinical presentation that otherwise varied considerably. The episodes persisted from several weeks to more than two years, and some of the patients had not recovered at the time of our last contact with them. The uniform clinical picture of TGA and the variable clinical picture of FRA presumably reflect their respective neurologic (‘organic’) and psychogenic (‘non-organic’) aetiologies.

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Platypnoea–orthodeoxia syndrome induced by short-term weight loss: a case series

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa498 ◽

2020 ◽

Author(s):

Yudai Tamura ◽

Tomohiro Sakamoto

Keyword(s):

Weight Loss ◽

Septal Defect ◽

Case Series ◽

Transoesophageal Echocardiography ◽

Sitting Position ◽

Short Time Period ◽

Time Period ◽

Uncommon Condition ◽

The Right ◽

Short Time

Abstract Background Platypnoea–orthodeoxia syndrome (POS) is an uncommon condition characterized by dyspnoea and arterial desaturation in the standing or sitting position that improves in the supine position. Case summary We report two cases of POS caused by an atrial septal defect (ASD) and a patent foramen ovale (PFO). Both cases reported a recent decrease in body weight of more than 10 kg in a short time period. Transoesophageal echocardiography (TOE) with agitated saline bubble study revealed and a large amount of contrast bubble through the ASD (Patient 1) or the PFO (Patient 2) from the right atrium to the left atrium in the sitting position. Both patients were diagnosed by the finding of positional dyspnoea and the results of TOE using agitated saline bubble contrast. Discussion Taken together, their presentations suggest that weight loss in a short time period could be a pathogenic factor for POS.

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Recovery from Transient Global Amnesia Following Restoration of Hippocampal and Fronto–Cingulate Perfusion

Behavioural Neurology ◽

10.1155/2010/768153 ◽

2010 ◽

Vol 22 (3-4) ◽

pp. 131-139 ◽

Cited By ~ 2

Author(s):

Paolo Caffarra ◽

Letizia Concari ◽

Simona Gardini ◽

Sabrina Spaggiari ◽

Francesca Dieci ◽

...

Keyword(s):

Acute Phase ◽

Neuropsychological Testing ◽

Transient Global Amnesia ◽

Normal Limits ◽

Global Amnesia ◽

One Year ◽

The Right ◽

Rcbf Spect ◽

Subject Comparison

A patient who suffered a transient global amnesia (TGA) attack underwent regional cerebral blood flow (rCBF) SPECT imaging and neuropsychological testing in the acute phase, after one month and after one year. Neuropsychological testing in the acute phase showed a pattern of anterograde and retrograde amnesia, whereas memory was within age normal limits at follow up. SPECT data were analysed with a within subject comparison and also compared with those of a group of healthy controls. Within subject comparison between the one month follow up and the acute phase detected increases in rCBF in the hippocampus bilaterally; further rCBF increases in the right hippocampus were detected after one year. Compared to controls, significant hypoperfusion was found in the right precentral, cingulate and medial frontal gyri in the acute phase; after one month significant hypoperfusion was detected in the right precentral and cingulate gyri and the left postcentral gyrus; after one year no significant hypoperfusion appeared. The restoration of memory was paralleled by rCBF increases in the hippocampus and fronto-limbic-parietal cortex; after one year neither significant rCBF differences nor cognitive deficits were detectable. In conclusion, these data indicate that TGA had no long lasting cognitive and neural alterations in this patient.

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Familial Retinal Arteriolar Tortuosity with Acute Hippocampal Infarction

Case Reports in Ophthalmology ◽

10.1159/000456069 ◽

2017 ◽

Vol 8 (1) ◽

pp. 185-189 ◽

Cited By ~ 1

Author(s):

Tae Hee Kim ◽

Sonia Lee ◽

Su Jin Lim

Keyword(s):

Past History ◽

Brain Magnetic Resonance Imaging ◽

Transient Global Amnesia ◽

Subcortical White Matter ◽

Blurred Vision ◽

Retinal Arterioles ◽

History Of ◽

Global Amnesia ◽

The Brain ◽

Retinal Arteriolar

Purpose: To report a case of familial retinal arteriolar tortuosity with acute hippocampal infarction. Method: Single-patient case report. Results: A 50-year-old woman presented with blurred vision and was found to have cataract, retinal hemorrhages, and tortuous retinal arterioles in both eyes. Similar findings of tortuous retinal arterioles were observed in her daughter and son. In her past history of 6 years prior to the visit, she had been diagnosed with transient global amnesia after brain magnetic resonance imaging, which showed hippocampal infarction and multiple chronic ischemic lesions in the periventricular and subcortical white matter. Conclusion: Familial retinal arteriolar tortuosity is known to affect the retinal vessels only. To our knowledge, this is the first report of ischemic injury to the brain in a patient with familial retinal arteriolar tortuosity.

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Transient Global Amnesia and Brain Tumour: Chance Concurrence or Aetiological Association Case Report and Systematic Literature Review

Case Reports in Neurology ◽

10.1159/000371840 ◽

2015 ◽

Vol 7 (1) ◽

pp. 18-25 ◽

Cited By ~ 6

Author(s):

Phil Milburn-McNulty ◽

Andrew J. Larner

Keyword(s):

Systematic Review ◽

Case Report ◽

Literature Review ◽

Brain Tumour ◽

Transient Global Amnesia ◽

Low Grade ◽

Review Of The Literature ◽

Global Amnesia ◽

The Right ◽

Clinical Diagnostic Criteria

We report a patient presenting with episodes of transient amnesia, some with features suggestive of transient global amnesia (TGA), and some more reminiscent of transient epileptic amnesia. Investigation with neuroimaging revealed an intrinsic lesion in the right amygdala, with features suggestive of low-grade neoplasia. We undertook a systematic review of the literature on TGA and brain tumour. Fewer than 20 cases were identified, some of which did not conform to the clinical diagnostic criteria for TGA. Hence, the concurrence of brain tumour and TGA is very rare and of doubtful aetiological relevance. In some brain tumour-associated cases, epilepsy may be masquerading as TGA.

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Successful transseptal puncture for radiofrequency ablation of left atrial tachycardia after closure of secundum atrial septal defect with Amplatzer septal occluder

Cardiology in the Young ◽

10.1017/s1047951110000168 ◽

2010 ◽

Vol 20 (2) ◽

pp. 226-228 ◽

Cited By ~ 4

Author(s):

Michala E. F. Pedersen ◽

Jaswinder S. Gill ◽

Shakeel A. Qureshi ◽

Christopher A. Rinaldi

Keyword(s):

Atrial Septal Defect ◽

Septal Defect ◽

Transoesophageal Echocardiography ◽

Atrial Arrhythmias ◽

Amplatzer Septal Occluder ◽

Transseptal Puncture ◽

Secundum Atrial Septal Defect ◽

Septal Occluder Device ◽

Occluder Device ◽

Catheter Closure

AbstractWe report on a 37-year-old woman presenting with atrial arrhythmias after catheter closure of a secundum atrial septal defect with an Amplatzer septal occluder device. Eletrophysiological studies suggested that the arrhythmia originated from the left atrium, from an area near the device. Transseptal puncture was successfully performed under transoesophageal guidance and the arrhythmia was successfully ablated. This case showed that transseptal puncture can be safely performed in the presence of an Amplatzer septal occluder device under transoesophageal echocardiography guidance and we speculate that the device may have created the substrate for the arrhythmia.

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