Prevalence of Mimics and Severe Comorbidity in Patients with Clinically Suspected Transient Global Amnesia

Anterograde Amnesia ◽

Underlying Disease ◽

Patient Treatment ◽

Imaging Data ◽

Clinical Criteria ◽

Alternative Diagnosis ◽

Extensive Evaluation ◽

Severe Comorbidity ◽

Background: Transient global amnesia (TGA) is a syndrome featuring acute anterograde amnesia as the most striking clinical symptom. Its etiology is still a matter of debate. Most neurological guidelines allow the diagnosis on the basis of clinical criteria only; a more extensive evaluation is recommended only for patients with “red flags” like severe headache, nausea or vomiting, or metabolic abnormalities. The aim of our study was to assess the frequency of a severe underlying disease or alternative diagnoses (mimics) in patients fulfilling the clinical criteria. Methods: We evaluated the medical records and the imaging data of an unselected consecutive cohort of patients with suspected TGA over a 7-year period. All patients were hospitalized and received a neurological workup including brain imaging, color-coded duplex sonography of the brain supplying arteries, electroencephalography, and laboratory studies of blood and (in selected cases) cerebrospinal fluid. Results: 163 patients with 166 episodes of suspected TGA were hospitalized (3 patients twice). After the workup, the diagnosis of TGA was confirmed in 148/166 (89.2%) episodes (“simple TGA”). Eighteen patients (10.8%) either had an alternative diagnosis or a severe comorbidity that was assumed to have had an impact on the occurrence of the amnestic episode (“complicated TGA/mimic”). The most important differential diagnosis was stroke (11 patients, 6.6% of all TGA suspects and 61.1% of the complicated TGA/mimic group). Other mimics were transient epileptic amnesia (2 patients) and steroid-induced delirium (1 patient). Important comorbidities that had not been obvious at the time of presentation were severe sleep apnea (2 patients), triptan overuse (1 patient), and an involuntary amlodipine intoxication during TGA. Conclusion: As approximately every tenth patient with suspected TGA either had an alternative diagnosis or a severe comorbidity, which had not been obvious at the time of admission, we consider in-patient treatment of all suspected TGA cases as appropriate, preferably in the setting of a stroke unit, as ischemic stroke was the by far most important diagnosis mimicking TGA.

Three sisters covering the transient global amnesia spectrum

International Psychogeriatrics ◽

10.1017/s1041610207005637 ◽

2007 ◽

Vol 19 (5) ◽

pp. 987-989 ◽

Cited By ~ 3

Author(s):

CHIARA AGOSTI ◽

BARBARA BORRONI ◽

NABIL AKKAWI ◽

ALESSANDRO PADOVANI

Keyword(s):

Anterograde Amnesia ◽

Abrupt Onset ◽

Venous Valve ◽

Major Life ◽

Clinical Criteria ◽

Emotional Trigger ◽

Global Amnesia ◽

Three Sisters ◽

Trigger Events

We report the case of an Italian family in which three sisters experienced transient global amnesia (TGA). Since its early description, this transitory pure memory deficit has attracted increasing interest, especially within the neurological community. In 1964 the term “TGA” was coined to identify the abrupt onset of anterograde amnesia, accompanied by repetitive queries lasting for hours and then gradually recovering, leaving an amnesic gap for the duration of the attack. Afterwards, many studies focused on TGA, and in 1990 clinical criteria were defined by Hodges and Warlow (1990). Further studies showed that meeting diagnostic criteria was a significant predictor for a better outcome than in other forms of transient amnesia, while amnesic patients who did not fulfil the TGA criteria had different outcomes. Precipitating and trigger events for TGA were identified and divided into physical and psychological factors (Inzitari et al., 1997; Quinette et al., 2006). Physical precipitants were found to be gardening, housework and sawing wood, contact with water and changes in body temperature occurring during hot baths or showers, or a cold swim at the swimming pool. Emotional trigger events included a major life or death event, emotional stress triggered by a gastric endoscopy, an exhausting work session, and anxiety resulting from conflicts at home or at work, health problems and money worries. Several hypotheses have been proposed for its pathogenesis such as psychogenic, venous dysfunction due to jugular venous valve incompetence, or ischemic aetiology, but the enigma of TGA still needs to be unravelled (Lewis, 1998; Akkawi et al., 2001).

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):

Anterograde Amnesia ◽

Epileptic Activity ◽

Sudden Onset ◽

Clinical Syndrome ◽

Slice Thickness ◽

Diagnostic Dilemma ◽

Monthly Basis ◽

Neurology Clinic ◽

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.

Transient global amnesia: Isolated event or healthy predictor? Clinical experience of an Italian Emergency Department

Emergency Care Journal ◽

10.4081/ecj.2019.8217 ◽

2019 ◽

Vol 15 (3) ◽

Author(s):

Greta Barbieri ◽

Alessandro Cipriano ◽

Simona Luly ◽

Viola Del Nista ◽

Eugenio Orsitto ◽

...

Keyword(s):

Emergency Department ◽

Neurological Diseases ◽

Anterograde Amnesia ◽

Acute Onset ◽

Clinical Syndrome ◽

Neurological Symptoms ◽

Self Awareness ◽

Benign Pathology ◽

Transient global amnesia (TGA) is a clinical syndrome characterized by reversible anterograde amnesia, in which the patient is alert, self-awareness appears intact and other neurological symptoms are absent. The diagnosis is based on the following criteria: i) witnessed event; ii) acute onset of anterograde amnesia; iii) no accompanying neurological symptoms; iv) no alteration of consciousness; v) no epileptic features; vi) resolution within 24 hours; vii) exclusion of other causes. We conducted a cohort study at the Department of Emergency Medicine on 119 patients with TGA diagnosis from 2010 to 2014, with follow-up evaluation by telephone interview. The objectives of our study were to evaluate the frequency of subsequent episodes, to identify predisposing factors, and to investigate whether TGA is a possible predictor of neurological disease. The frequency of comorbidity in our population was in line with literature. We observed a recurrence rate of 9.5%, with a prevalence for the male gender, while no other factor correlates with TGA recurrence. TGA was not a predictor of further neurological diseases. In conclusion, TGA is a benign pathology with a low probability of relapse. Accordingly, management in Emergency Department should be based on a correct initial clinical classification for rapid discharge.

Concussion Causing Transient Global Amnesia: Further Insights Into Pathophysiology?

Neurology ◽

10.1212/01.wnl.0000720020.86134.9d ◽

2020 ◽

Vol 95 (20 Supplement 1) ◽

pp. S16.1-S16

Author(s):

Basit Shah ◽

Mohammed Wasif Hussain

Keyword(s):

Vasogenic Edema ◽

Case Reports ◽

Anterograde Amnesia ◽

Imaging Findings ◽

Rare Presentation ◽

Neurologic Deficits ◽

Ct Head ◽

ObjectiveTo review a rare presentation of Transient Global Amnesia (TGA) in context of concussion with reversible imaging findings.BackgroundTGA is characterized by sudden temporary loss of anterograde memory accompanied by repetitive questioning without focal neurologic deficits. While risk factors of age above 50 and migraines remain constant, a clear cause is unknown. The association between TGA and concussion is not well defined beyond 2 case reports in the literature. We review the existing literature and examine a case of TGA in temporal relationship to mild traumatic brain injury (mTBI) or concussion.Design/MethodsCase Report.ResultsA healthy 38-year-old male with no prior concussions or headaches, sustained a concussion after falling backward on pavement. He presented to the emergency room with retrograde amnesia of events 1 hour prior to his injury with subsequent anterograde amnesia. His exam demonstrated normal language and speech and no other focal neurologic deficits. He was diagnosed with TGA with symptoms lasting for 16 hours before fully resolving. Approximately 24 hours after his injury, he developed a migraine headache and tinnitus that was worse with exertion, lasting for roughly 12 hours. His initial CT head while symptomatic demonstrated an area of hypodensity within the left anterior temporal lobe. 2 days after his presentation, he had an MRI with DWI/SWI as well as an EEG, all of which were completely normal, with complete resolution of the finding on CT. He had no further symptoms after his headache resolved and no recurrence of TGA after 12 months follow-up.ConclusionsTGA presenting after a concussion has rarely been reported. We report such a case with imaging findings present during the acute phase that were not present on subsequent MRI suggesting possible reversible vasogenic edema. This may provide insights into the pathophysiology of TGA in this population.

105 A presentation resembling transient global amnesia with underlying tako-tsubo cardiomyopathy and multifocal ischaemic stroke (with restricted diffusion in the left mesiotemporal lobe)

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2019-anzan.93 ◽

2019 ◽

Vol 90 (e7) ◽

pp. A34.2-A34

Author(s):

Kristen Lefever ◽

Chloe Tyson ◽

Lisa Shelley ◽

Daniel Schweitzer ◽

Andrew Swayne

Keyword(s):

Ischaemic Stroke ◽

Alternative Hypothesis ◽

Single Case ◽

Anterograde Amnesia ◽

Left Ventricular ◽

Restricted Diffusion ◽

List Type ◽

Tako Tsubo Cardiomyopathy ◽

IntroductionWe present a case of a 65 year-old female with a presentation resembling transient global amnesia (TGA) with investigations revealing a Tako-tsubo cardiomoyopathy and multifocal punctate areas of restricted diffusion consistent with ischaemic stroke.MethodsSingle case report.ResultsA 65 year-old female presented altered behaviour with anterograde amnesia consistent with an episode of TGA. There was no clearly identifiable stressor to provoke this episode. The TGA-like symptoms persistent for 12 hours before the patient made a full recovery.During the presentation the patient complained of chest pain with elevated troponin. Cardiac investigation was notable for mild left ventricular dilation with mid- and apical hypokinesis on transthoracic echocardiogram and a normal coronary angiogram consistent with Tako-tsubo cardiomyopathy. Magnetic resonance imaging of the brain revealed multifocal infarcts including punctate foci of restricted diffusion within the left mesiotemporal lobe.ConclusionThis case is notable as it is rare to have a combined presentation with TGA-type symptoms with Tako-tsubo cardiomyopathy and multifocal ischaemia stroke.1 This is the first clinical case presentation involving the aforementioned triad and mesiotemporal lobe restricted diffusion. We hypothesise that the Tako-tsubo cardiomyopathy acted as the triggering event and the mesiotemporal lobe involvement caused the TGA-like symptoms thereby accounting for the clinical presentation and investigation findings. As mesiotemporal/hippocampal restricted diffusion may be seen with transient global amnesia,2 this case is of special interest mechanistically although we cannot exclude the alternative hypothesis that the episode of TGA resulted in the Tako-tsubo cardiomyopathy which subsequently caused the cardioembolic shower.ReferencesStollberger C, DeCillia N, Finsterer J. ‘Tako-tsubo cardiomyopathy with transient global amnesia and cerebellar embolic stroke triggered by existential fear.’Neurol Neurochir Pol 2018; 52(3):394–396.Enzinger C, Thimary F, Kapeller P, Ropele S, Schmidt R, Ebner F, Fazekas F. ‘Transient global amnesia: diffusion-weighted imaging lesions and cerebrovascular disease.’Stroke 2008;39(8):2219–2225.

Transient global amnesia and brain lesions: new hints into clinical criteria

European Journal of Neurology ◽

10.1111/j.1468-1331.2008.02250.x ◽

2008 ◽

Vol 15 (9) ◽

pp. 981-984 ◽

Cited By ~ 10

Author(s):

C. Agosti ◽

B. Borroni ◽

N. M. Akkawi ◽

G. De Maria ◽

A. Padovani

Keyword(s):

Brain Lesions ◽

Clinical Criteria ◽

Transient global amnesia with bilateral hippocampal findings in magnetic resonance imaging

Brain and Neurological Disorders ◽

10.31579/2642-973x/011 ◽

2020 ◽

Vol 3 (1) ◽

pp. 01-03

Author(s):

Sonia P. Rodriguez ◽

Alfredo Fernandez de Castro ◽

Carlos Enrique Trillos Peña

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Personal Identity ◽

Anterograde Amnesia ◽

Acute Onset ◽

Unknown Etiology ◽

Imaging Findings ◽

Resonance Imaging ◽

Transient global amnesia (TGA) is an unusual neurological syndrome of unknown etiology that affects individuals between 50 and 75 years old. We describe the case of a 61-year-old woman, who experienced an episode of two hours of anterograde amnesia. The event had an acute onset and was observed by a reliable witness. It lacked motor or sensory symptoms, compromised consciousness, or personal identity. A brain magnetic resonance was performed 22 hours after the onset of symptoms depicting foci of restricted diffusion in both hippocampi. Taking into account clinical and imaging findings, the diagnosis of transient global amnesia was made.

Transient global amnesia following transoesophageal echocardiography

BMJ Case Reports ◽

10.1136/bcr-2020-234751 ◽

2020 ◽

Vol 13 (4) ◽

pp. e234751

Author(s):

Mark Philip Cassar ◽

Katrin Balkhausen

Keyword(s):

Septal Defect ◽

Anterograde Amnesia ◽

Transoesophageal Echocardiography ◽

Sudden Onset ◽

Clinical Suspicion ◽

Secundum Atrial Septal Defect ◽

Global Amnesia ◽

The Right ◽

The Brain

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.

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 ◽

Anterograde Amnesia ◽

Sudden Onset ◽

Memory Problems ◽

Essentially Normal ◽

Amnesic Syndrome ◽

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.

A Forgetful Experience: A Case of Transient Global Amnesia

Canadian Journal of General Internal Medicine ◽

10.22374/cjgim.v9i4.10 ◽

1970 ◽

Vol 9 (4) ◽

Author(s):

Kalpa Shah MD PGY2 ◽

Chris Sheasgreen MD PGY3 ◽

Ameen Patel MB

Keyword(s):

Acute Onset ◽

Clinical Syndrome ◽

Benign Condition ◽

Clinical Criteria ◽

Global Amnesia ◽

Criteria For Diagnosis ◽

Diagnostic Work ◽

Work Up ◽

Diagnostic Work Up

We present a case of a 67-year-old man with transient global amnesia, a clinical syndrome that presents with an acute onset of temporary amnesia lasting less than 24 hours, without impairment of consciousness or cognition. In this article, we discuss the clinical criteria for diagnosis, the pathophysiology of the condition, and an approach to its diagnostic work-up and prognosis. It is important to differentiate TGA from other entities because it is a benign condition that does not require treatment.