PDF herunterladen
CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2019; 77(01): 3-9
DOI: 10.1590/0004-282X20180157
Article

Transient global amnesia: clinical features and prognostic factors suggesting recurrence

Amnesia global transitoria: características clínicas y factores pronósticos sugestivos de recurrencia
Lucas Alessandro 
1   Raúl Carrea Institute for Neurological Research (FLENI), Department of Neurology, Buenos Aires, Argentina;
,
Ismael L. Calandri
1   Raúl Carrea Institute for Neurological Research (FLENI), Department of Neurology, Buenos Aires, Argentina;
,
Marcos Fernández Suarez
2   Raúl Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina;
,
María L. Heredia
2   Raúl Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina;
,
Hernán Chaves
3   Department of Diagnostic Imaging, Raúl Carrea Institute for Neurological Research (FLENI), Department of Neurology, Buenos Aires, Argentina;
,
Ricardo F. Allegri
1   Raúl Carrea Institute for Neurological Research (FLENI), Department of Neurology, Buenos Aires, Argentina;
,
Mauricio F. Farez
4   Center for Research on Neuroimmunological Diseases (CIEN), Raúl Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina.
› Institutsangaben
› Weitere Informationen
Auch verfügbar auf
   Lizenzen und Reprints

ABSTRACT

The risk of recurrence of new amnesia events in patients having previously experienced transient global amnesia (TGA) ranges between 2.9-23.8%.

Objective: Our objective was to search for recurrence predictors in TGA patients.

Methods: Retrospective analysis to identify recurrence predictors in a cohort of 203 TGA patients from a single center in Buenos Aires, Argentina, diagnosed between January 2011 and March 2017 Clinical features and complementary studies (laboratory results, jugular vein Doppler ultrasound and brain MRI) were analyzed. Comparison between patients with recurrent versus single episode TGA was performed, applying a multivariate logistic regression model.

Results: Mean age at presentation was 65 years (20-84); 52% were female. Median time elapsed between symptom onset and ER visit was two hours, with the average episode duration lasting four hours. Mean follow-up was 22 months. Sixty-six percent of patients referred to an identifiable trigger. Jugular reflux was present in 66% of patients; and 22% showed images with hippocampus restriction on diffusion-weighted MRI. Eight percent of patients had TGA recurrence. Patients with recurrent TGA had a more frequent history of migraine than patients without recurrence (37.5% vs. 14%; p = 0.03). None of the other clinical characteristics and complementary studies were predictors of increased risk of recurrence.

Conclusions: Patients with migraine may have a higher risk of recurrent TGA. None of the other clinical characteristics evaluated allowed us to predict an increased risk of recurrence. Although the complementary studies allowed us to guide the diagnosis, they did not appear to have a significant impact on the prediction of recurrence risk.

RESUMEN

El riesgo de recurrencia de nuevos eventos de amnesia en pacientes que han experimentado previamente Amnesia Global Transitoria (AGT) oscila entre el 2.9-23.8%.

Objetivo: Nuestro objetivo fue buscar predictores de recurrencia en pacientes con AGT.

Métodos: Análisis retrospectivo de una cohorte de 203 pacientes con AGT de un único centro en Buenos Aires, Argentina, diagnosticados entre enero-2011 y marzo-2017 Se analizaron las características clínicas y los estudios complementarios (laboratorio, Doppler de vena yugular y RM encéfalo). Se comparó el grupo de AGT recurrente versus episodio único, aplicando un modelo de regresión logística multivariada.

Resultados: la edad promedio de presentación fue de 65 años (20-84); 52% mujeres. La mediana del tiempo transcurrido entre el inicio de los síntomas y la visita a la sala de emergencia fue de 2 horas, con una duración promedio del episodio de 4 horas. El seguimiento medio fue de 22 meses. 66% de los pacientes tuvieron un desencadenante identificable. El reflujo yugular estuvo presente en el 66% de los pacientes y el 22% mostró imágenes restrictivas en DWI a nivel hipocampal. 8% de los pacientes presentaron recurrencia. Los pacientes con AGT recurrente tuvieron un historial de migraña más frecuente (37.5% vs. 14%; p=0.03). Ninguna de las otras características clínicas y estudios complementarios fueron predictores de mayor riesgo de recurrencia.

Conclusiones: los pacientes con migraña pueden tener un mayor riesgo de recurrencia de AGT. Ninguna de las otras características clínicas evaluadas nos permitió predecir un mayor riesgo de recurrencia. Aunque los estudios complementarios nos permitieron orientar el diagnóstico, no pareció tener un impacto significativo en la predicción del riesgo de recurrencia.

Keywords:

Amnesia, anterograde - recurrence - amnesia, transient global

Palabras-clave:

Amnesia anterógrada - recurrencia - amnesia global transitoria


Publikationsverlauf

Eingereicht: 14. Juni 2018

Angenommen: 17. Oktober 2018

Artikel online veröffentlicht:
21. August 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 Hodges JR, Warlow CP. Syndromes of transient amnesia: towards a classification. A study of 153 cases. J Neurol Neurosurg Psychiatry. 1990 Oct;53(10):834-43. https://doi.org/10.1136/jnnp.53.10.834
  • 2 Lauria G, Gentile M, Fasseta G, Casetta I, Caneve G. Incidence of transient global amnesia in the Belluno province, Italy: 1985 through 1995. Acta Neurol Scand. 1997;95(5):303-10. https://doi.org/10.1111/j.1600-0404.1997.tb00215.x
  • 3 Miller JW, Petersen RC, Metter EJ, Millikan CH, Yanagihara T. Transient global amnesia: clinical characteristics and prognosis. Neurology. 1987 May;37(5):733-7. https://doi.org/10.1212/WNL.375.733
  • 4 Koski KJ, Marttila RJ. Transient global amnesia: incidence in an urban population. Acta Neurol Scand. 1990 Apr;81(4):358-60. https://doi.org/10.1111/j.1600-0404.1990.tb01571.x
  • 5 Miller JW, Yanagihara T, Petersen RC, Klass DW. Transient global amnesia and epilepsy. Electroencephalographic distinction. Arch Neurol. 1987 Jun;44(6):629-33. https://doi.org/10.1001/archneur.1987.00520180049015
  • 6 Melo TP, Ferro JM, Ferro H. Transient global amnesia. A case control study. Brain. 1992 Feb;115(Pt 1):261-70. https://doi.org/10.1093/brain/115.1.261
  • 7 Quinette P, Guillery-Girard B, Dayan J, de la Sayette V, Marquis S, Viader F, et al. What does transient global amnesia really mean? Review of the literature and thorough study of 142 cases. Brain. 2006 Jul;129(Pt 7):1640-58. https://doi.org/10.1093/brain/awl105
  • 8 Bartsch T, Butler C. Transient amnesic syndromes. Nat Rev Neurol. 2013 Feb;9(2):86-97. https://doi.org/10.1038/nrneurol.2012.264
  • 9 Butler CR, Zeman AZ. Recent insights into the impairment of memory in epilepsy: transient epileptic amnesia, accelerated long-term forgetting and remote memory impairment. Brain. 2008 Sep;131(Pt 9):2243-63. https://doi.org/10.1093/brain/awn127
  • 10 Bartsch T, Alfke K, Stingele R, Rohr A, Freitag-Wolf S, Jansen O, et al. Selective affection of hippocampal CA-1 neurons in patients with transient global amnesia without long-term sequelae. Brain. 2006 Nov;129(Pt 11):2874-84. https://doi.org/10.1093/brain/awl248
  • 11 Bermejo-Velasco PE, Castillo-Moreno L, Escamilla-Crespo C. [Transient global amnesia associated to hypopotassemia]. Rev Neurol. 2006;42(4):255-6. Spanish.
  • 12 Kemeny ME, Schedlowski M. Understanding the interaction between psychosocial stress and immune-related diseases: a stepwise progression. Brain Behav Immun. 2007 Nov;21(8):1009-18. https://doi.org/10.1016/j.bbi.2007.07.010
  • 13 Jin R, Yang G, Li G. Inflammatory mechanisms in ischemic stroke: role of inflammatory cells. J Leukoc Biol. 2010 May;87(5):779-89. https://doi.org/10.1189/jlb.1109766
  • 14 Buck BH, Liebeskind DS, Saver JL, Bang OY, Yun SW, Starkman S et al. Early neutrophilia is associated with volume of ischemic tissue in acute stroke. Stroke. 2008 Feb;39(2):355-60. https://doi.org/10.1161/STROKEAHA.107.490128
  • 15 Lewis SL. Aetiology of transient global amnesia. Lancet. 1998 Aug;352(9125):397-9. https://doi.org/10.1016/S0140-6736(98)01442-1
  • 16 Cejas C, Cisneros LF, Lagos R, Zuk C, Ameriso SF. Internal jugular vein valve incompetence is highly prevalent in transient global amnesia. Stroke. 2010 Jan;41(1):67-71. https://doi.org/10.1161/STROKEAHA.109.566315
  • 17 Maalikjy Akkawi N, Agosti C, Anzola GP, Borroni B, Magoni M, Pezzini A et al. Transient global amnesia: a clinical and sonographic study. Eur Neurol. 2003;49(2):67-71. https://doi.org/10.1159/000068501
  • 18 Sedlaczek O, Hirsch JG, Grips E, Peters CN, Gass A, Wöhrle J et al. Detection of delayed focal MR changes in the lateral hippocampus in transient global amnesia. Neurology. 2004 Jun;62(12):2165-70. https://doi.org/10.1212/01.WNL.0000130504.88404.C9
  • 19 Weon YC, Kim JH, Lee JS, Kim SY. Optimal diffusion-weighted imaging protocol for lesion detection in transient global amnesia. AJNR Am J Neuroradiol. 2008 Aug;29(7):1324-8. https://doi.org/10.3174/ajnr.A1105
  • 20 Arena JE, Brown RD, Mandrekar J, Rabinstein AA. Long-term outcome in patients with transient global amnesia: a population-based study. Mayo Clin Proc. 2017 Mar;92(3):399-405. https://doi.org/10.1016/j.mayocp.2016.11.015
  • 21 Auyeung M, Tsoi TH, Cheung CM, Fong DY, Li R, Chan JK et al. Association of diffusion weighted imaging abnormalities and recurrence in transient global amnesia. J Clin Neurosci. 2011 Apr;18(4):531-4. https://doi.org/10.1016/j.jocn.2010.08.019
  • 22 Zorzon M, Antonutti L, Masè G, Biasutti E, Vitrani B, Cazzato G. Transient global amnesia and transient ischemic attack. Natural history, vascular risk factors, and associated conditions. Stroke. 1995 Sep;26(9):1536-42. https://doi.org/10.1161/01.STR.26.9.1536
  • 23 Pantoni L, Bertini E, Lamassa M, Pracucci G, Inzitari D. Clinical features, risk factors, and prognosis in transient global amnesia: a follow-up study. Eur J Neurol. 2005 May;12(5):350-6. https://doi.org/10.1111/j.1468-1331.2004.00982.X
  • 24 Gandolfo C, Caponnetto C, Conti M, Dagnino N, Del Sette M, Primavera A. Prognosis of transient global amnesia: a long-term follow-up study. Eur Neurol. 1992;32(1):52-7. https://doi.org/10.1159/000116787
  • 25 Klötzsch C, Sliwka U, Berlit P, Noth J. An increased frequency of patent foramen ovale in patients with transient global amnesia. Analysis of 53 consecutive patients. Arch Neurol. 1996 Jun;53(6):504-8. https://doi.org/10.1001/archneur.1996.00550060046014
  • 26 Lin KH, Chen YT, Fuh JL, Li SY, Chen TJ, Tang CH, et al. Migraine is associated with a higher risk of transient global amnesia: a nationwide cohort study. Eur J Neurol. 2014 May;21(5):718-24. https://doi.org/10.1111/ene.12346
  • 27 Chung CP, Chao AC, Hsu HY, Lin SJ, Hu HH. Decreased jugular venous distensibility in migraine. Ultrasound Med Biol. 2010 Jan;36(1):11-6. https://doi.org/10.1016/j.ultrasmedbio.2009.08.007
  • 28 Chou CH, Fuh JL, Wang SJ, Hu HH, Wu JC, Cheng YT. Queckenstedt's test headache response is associated with increased jugular venous flow volume during migraine attack. Ultrasound Med Biol. 2011 Jan;37(1):23-8. https://doi.org/10.1016/j.ultrasmedbio.2010.10.018
  • 29 Di Filippo M, Calabresi P. Ischemic bilateral hippocampal dysfunction during transient global amnesia. Neurology. 2007 Jul;69(5):493. https://doi.org/10.1212/01.wnl.0000271085.87627.72
  • 30 Jacome DE. EEG features in transient global amnesia. Clin Electroencephalogr. 1989 Jul;20(3):183-92. https://doi.org/10.1177/155005948902000312