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1.
Emergencias (Sant Vicenç dels Horts) ; 31(5): 341-345, oct. 2019. tab
Artículo en Español | IBECS | ID: ibc-184124

RESUMEN

Objetivo. Conocer la epidemiología de las consultas en urgencias por amnesia global transitoria (AGT), ya sea pura, asociada al consumo de tóxicos o en el contexto de una agresión sexual. Método. Estudio retrospectivo de enero a diciembre de 2018. Se revisaron las AGT atendidas en intoxicados (AGTtox), en víctimas de agresiones sexuales (AGTsex) y las amnesias puras (AGTpur), evaluando la presencia de tóxicos. Resultados. Se identificaron 287 AGT: 169 AGTsex (58,9%), 62 AGTpur (21,6%) y 56 AGTtox (19,5%). De ellas, 218 (76%) fueron mujeres y la edad osciló entre 16 y 90 años (60,6% menores de 30 años). Reconocieron consumo de alcohol 201 casos (72,8%), con etanolemia positiva en 105 (49,1%) (media de 0,74 g/l y máxima de 3,9 g/l). Admitieron consumo de cannabis 20 pacientes (7,1%), con analítica positiva en 39 casos (17,3%); cocaína 14 (4,9%), con analítica positiva en 28 (12,4%), y anfetaminas 5 (1,7%), con analítica positiva en 20 (8,8%). Presentaron sínto-mas de intoxicación 58 casos (20,1%). Cuatro pacientes ingresaron en coma. Se realizó una tomografía computariza-da (TC) craneal a 66 pacientes (23%), se hospitalizaron 7 y no hubo ningún fallecimiento. Conclusiones. La prevalencia de AGT es mayor si se incluyen los intoxicados y las agresiones sexuales, modificando la determinación de tóxicos la epidemiología de la AGT en urgencias


Objectives. To study the epidemiology of emergency department visits for transient global amnesia (TGA) by itself or associated with substance abuse or sexual assault. Methods. Retrospective study of cases treated from January to December 2018. Data for all patients with TGA were extracted, and cases were classified as associated with substance abuse (TGASUB), sexual assault (TGASEX), or neither (TGAONLY). Results. A total of 287 TGA cases were found: 169 (58.9%) were TGASEX, 62 (21.6%) TGAONLY, and 56 (19.5%) TGASUB. Two hundred eighteen (76%) were female and 69 (24%) were male. Ages ranged from 16 to 90 years; 174 (60.6%) were under the age of 30 years. Two hundred one patients (72.8%) reported consuming alcohol; and 105 (49.1%) were positive on testing (mean blood alcohol concentration, 0.74 g/L; maximum, 3.9 g/L. Twenty patients (7.1%) reported using cannabis, and 39 (17.3%) had positive test results; 14 reported using cocaine (4.9%) and 28 (12.4%) tested positive; 5 (1.7%) reported using amphetamines and 20 (8.8%) tested positive. Fifty-eight (20.1%) had symptoms of intoxication. Four were admitted in coma. A computed tomography scan was ordered for 66 patients (23%), 7 patients were hospitalized, and none died. Conclusions. The prevalence of TGA is higher if cases of substance abuse and sexual assault are counted. Toxicolgy testing changes the epidemiology of TGA in emergencies


Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Amnesia Global Transitoria/complicaciones , Amnesia Global Transitoria/epidemiología , Trastornos Relacionados con Sustancias/complicaciones , Servicios Médicos de Urgencia/métodos , Delitos Sexuales , Síntomas Toxicológicos/efectos adversos , Estudios Retrospectivos , Coma/complicaciones , Coma/diagnóstico por imagen , Tomografía Computarizada de Emisión , Etanol/toxicidad , Cocaína/toxicidad , Cannabis/toxicidad , Anfetaminas/toxicidad , Análisis de Varianza
2.
Neurology ; 92(3): e234-e243, 2019 01 15.
Artículo en Inglés | MEDLINE | ID: mdl-30552301

RESUMEN

OBJECTIVE: To investigate long-term recovery of allocentric and egocentric spatial orientation as a sensitive marker for hippocampal and extrahippocampal network function in transient global amnesia (TGA). METHODS: A group of 18 patients with TGA performed an established real-space navigation paradigm, requiring allo- and egocentric spatial orientation abilities, 3 days (postacute stage) and 3 months (follow-up) after symptom onset. Visual exploration behavior and navigation strategy were documented by a gaze-controlled, head-fixed camera. Allo- and egocentric spatial orientation performance was compared to that of 12 age-matched healthy controls. Navigation-induced brain activations were measured using [18F]-fluorodeoxyglucose-PET in a subgroup of 8 patients in the postacute stage and compared to those of the controls. RESULTS: In the postacute stage, the patients navigated worse and had higher error rates than controls in allocentric (p = 0.002), but not in egocentric, route planning (p = 0.30), despite complete recovery of verbal (p = 0.58) and figural memory (p = 0.11). Until follow-up, allocentric navigation deficits improved, but higher error rates and reduced use of shortcuts persisted (p < 0.0001). Patients still exhibited relatively more fixations of unique landmarks during follow-up (p = 0.05). PET measurements during the postacute stage showed increased navigation-induced brain activations in the right hippocampus, bilateral retrosplenial, parietal, and mesiofrontal cortices, and cerebellar dentate nucleus in patients compared to controls (p < 0.005). CONCLUSIONS: Patients with TGA show selective and prolonged deficits of allocentric spatial orientation. Activations in right hippocampal and extrahippocampal hubs of the cerebral navigation network functionally substitute for the deficit in creating and updating the internal cognitive map in TGA.


Asunto(s)
Amnesia Global Transitoria/complicaciones , Amnesia Global Transitoria/patología , Hipocampo/patología , Trastornos de la Percepción/etiología , Navegación Espacial/fisiología , Anciano , Amnesia Global Transitoria/diagnóstico por imagen , Atención/fisiología , Estudios de Casos y Controles , Femenino , Fluorodesoxiglucosa F18/farmacocinética , Estudios de Seguimiento , Hipocampo/efectos de los fármacos , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Orientación/fisiología , Trastornos de la Percepción/diagnóstico por imagen , Tomografía de Emisión de Positrones
3.
Medicine (Baltimore) ; 97(41): e12723, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30313071

RESUMEN

INTRODUCTION: Transient global amnesia (TGA) is characterized by a sudden onset of anterograde and retrograde amnesia, sometimes associated with mild subclinical neuropsychological deficits and vegetative symptoms, lasting for days after the episode. Migraine history, cardiovascular risk factors, and emotional stress are considered possible risk factors. TGA usually occurs during the seventh decade of life, that is, when risk factors and concomitant pathologies have a higher incidence. CASE PRESENTATION: We report 3 cases of TGA triggered by different causes (cardiovascular risk factors, emotional stress, and orgasm) with an unusual young onset (patient 1 was a 40-year-old woman, patient 2 was a 21-year-old woman, and patient 3 a 32-year-old man). The patients underwent neuroimaging and cardiovascular examination, and neuropsychological evaluation, without important abnormalities. TGA completely recovery within 1 to 7 days. CONCLUSIONS: The occurrence of different precipitating events and accurate questioning (in the absence of head trauma) seem to be key features in making the diagnosis of TGA, besides a complete neuropsychiatric and cardiovascular assessment.


Asunto(s)
Amnesia Global Transitoria/complicaciones , Enfermedades Cardiovasculares/complicaciones , Femenino , Humanos , Masculino , Orgasmo/fisiología , Factores de Riesgo , Estrés Psicológico/complicaciones , Adulto Joven
5.
BMJ Case Rep ; 20172017 Jul 14.
Artículo en Inglés | MEDLINE | ID: mdl-28710234

RESUMEN

Takotsubo cardiomyopathy (TTC) is associated with acute, reversible left ventricular (LV) dysfunction, while transient global amnesia (TGA) is a reversible disorder of the brain characterised by anterograde amnesia. We report an unusual case of TTC occurring concurrently in a patient with TGA, and propose that catecholamine surge induced cerebral venous congestion and cardiotoxicity is the shared aetiology that leads to the concurrent manifestation of these conditions. TTC and TGA are reversible disorders that can occur concurrently in a subset of patients due to a unifying aetiology, catecholamine excess, leading to pathophysiological changes within the brain and the myocardium.


Asunto(s)
Amnesia Global Transitoria/diagnóstico , Cardiomiopatía de Takotsubo/diagnóstico , Amnesia Global Transitoria/complicaciones , Amnesia Global Transitoria/fisiopatología , Dolor en el Pecho/etiología , Diagnóstico Diferencial , Electrocardiografía , Urgencias Médicas , Femenino , Humanos , Persona de Mediana Edad , Cardiomiopatía de Takotsubo/complicaciones , Cardiomiopatía de Takotsubo/fisiopatología
6.
Intern Med ; 56(12): 1569-1573, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28626186

RESUMEN

A 65-year-old man who had been diagnosed with transient global amnesia (TGA) 15 years previously was admitted to hospital with complaints of amnesia and headache. His symptoms improved on day-2. The initial brain MRI and electroencephalography findings were normal. He was diagnosed with a recurrence of TGA and discharged. However, he returned with right leg weakness and complained of a thunderclap headache. MRI demonstrated subarachnoid hemorrhage and multifocal segmental narrowing of the left posterior cerebral artery (PCA) and large intracranial arteries, and he was diagnosed with reversible cerebral vasoconstriction syndrome (RCVS). He was discharged on day-30 without any neurological deficits. This case suggested that TGA should be interpreted as one of the symptoms of RCVS or a prodromal symptom of RCVS.


Asunto(s)
Amnesia Global Transitoria/complicaciones , Arteria Cerebral Posterior , Hemorragia Subaracnoidea/diagnóstico , Vasoconstricción , Anciano , Cefaleas Primarias , Humanos , Masculino , Hemorragia Subaracnoidea/etiología , Síndrome
7.
Int J Stroke ; 12(3): 292-296, 2017 04.
Artículo en Inglés | MEDLINE | ID: mdl-28112030

RESUMEN

Background Small punctuate lesions in the hippocampus on diffusion-weighted images are a typical finding in transient global amnesia. Consequently, it has been suggested that diffusion-weighted images findings might corroborate the diagnosis of transient global amnesia. However, isolated punctuate hippocampal infarction might be a differential diagnosis of transient global amnesia. Aim Evaluation of isolated punctuate hippocampal infarction frequency and comparison of its clinical presentation and MRI findings to transient global amnesia. Methods From an MRI database, we identified 10 patients with isolated punctuate hippocampal infarction and compared these to 12 patients with transient global amnesia with diffusion-weighted images lesion with regard to clinical symptoms and MRI findings. Results Disorientation and memory deficits were more common in transient global amnesia patients, whereas dysphasia/aphasia and vertigo were more common in hippocampal infarction patients. MRI findings in isolated punctuate hippocampal infarction and transient global amnesia did not differ significantly, neither regarding the affected hemisphere, lesion distribution, size, nor relative ADC values. Conclusions Differentiation of isolated punctuate hippocampal infarction and transient global amnesia based on neuroimaging findings is not possible. Thus, in the case of isolated punctuate hippocampal diffusion-weighted images lesions the final diagnosis of hippocampal infarction or transient global amnesia should be based on the clinical presentation.


Asunto(s)
Amnesia Global Transitoria/diagnóstico por imagen , Infarto Encefálico/diagnóstico por imagen , Imagen de Difusión por Resonancia Magnética , Hipocampo/diagnóstico por imagen , Anciano , Amnesia Global Transitoria/complicaciones , Amnesia Global Transitoria/psicología , Infarto Encefálico/complicaciones , Infarto Encefálico/psicología , Bases de Datos Factuales , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
8.
J Neuropsychol ; 11(1): 108-121, 2017 03.
Artículo en Inglés | MEDLINE | ID: mdl-26179568

RESUMEN

INTRODUCTION: Recent studies have shown that patients with transient global amnesia (TGA) experience a depressive mood during the episode. However, little evidence has been found of possible mood congruency effects on memory, which are probably masked by the massive anterograde amnesia. An implicit assessment could provide a means of settling this question. METHODS: First, we measured patients' emotional states on psychopathological scales. Second, we administered a lexical decision task to assess three priming effects: Semantic priming (SP; table-chair), emotional priming (EP; murder-garbage), and emotional plus semantic priming (ESP; cemetery-coffin). RESULTS: Patients displayed a more depressed mood than controls. For patients, we found a SP effect in the ESP condition and a striking inhibition effect (i.e., negative target recognized more slowly when preceded by a negative prime rather than a neutral one) in the EP condition. For controls, a priming effect was found in the SP and ESP conditions, but not the EP condition. Finally, whereas the priming effect was greater in SP than in the other two conditions for controls, for patients it was the EP condition that stood out from the other two, being the only condition that led to an inhibition effect. CONCLUSIONS: We highlighted a mood congruency effect in TGA which could impel patients to focus their attention on negative information. While the negative valence of items always led to a slowdown in reaction times for both patients and controls, attesting to a negativity bias, this bias was greater in patients, leading to an inhibition effect.


Asunto(s)
Amnesia Global Transitoria/complicaciones , Amnesia Global Transitoria/psicología , Trastorno Depresivo/etiología , Memoria/fisiología , Anciano , Aprendizaje por Asociación , Toma de Decisiones/fisiología , Trastorno Depresivo/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Escalas de Valoración Psiquiátrica , Tiempo de Reacción/fisiología , Estadísticas no Paramétricas
9.
Neurocase ; 23(1): 22-25, 2017 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-28004602

RESUMEN

The acute onset of isolated amnesia is an intriguing challenge for neurologist, because the lack of associated signs can be misleading for diagnosis. The most common cause is transient global amnesia (TGA), a benign condition, but rarely it results from abuse of substance/alcohol or cerebrovascular diseases. In the latter, the brain region involved is the hippocampus. We describe a patient with presenting symptoms of TGA, but affected by an ischemic hippocampal stroke. The computed tomography angiography helped the etiologic diagnosis showing an hemodynamic stenosis of the posterior P2P segment. Interestingly, neuropsychological features were consistent with those found in patients suffering TGA.


Asunto(s)
Amnesia Global Transitoria/complicaciones , Hipocampo/patología , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/patología , Anciano de 80 o más Años , Amnesia Global Transitoria/diagnóstico por imagen , Femenino , Hipocampo/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Pruebas Neuropsicológicas , Accidente Cerebrovascular/diagnóstico por imagen , Aprendizaje Verbal/fisiología
10.
J Stroke Cerebrovasc Dis ; 26(1): e27-e28, 2017 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-27863873

RESUMEN

A 67-year-old right-handed woman experienced a sudden anterograde and retrograde short-term memory deficit that recovered on the next day. Magnetic resonance imaging (MRI) showed a spotty high-intensity lesion in the left putamen in the diffusion-weighted and fluid-attenuated inversion recovery images. Transient global amnesia due to lacunar infarction of the left putamen was diagnosed. Transient global amnesia is characterized by a sudden onset of anterograde amnesia that disappears within 24 hours. The cause of transient global amnesia is still uncertain. Some studies with MRI showed small lesions in the hippocampus at 24-74 hours after the episode. These lesions disappear within several weeks. However, our case of transient global amnesia showed a small lesion in the left putamen, not the hippocampus. Some studies with functional MRI reported that the stratum plays an important role in short-term memory and cognitive function. This case showed only a left putamen lesion, which indicates that a putamen lesion can cause transient global amnesia.


Asunto(s)
Amnesia Global Transitoria/complicaciones , Infarto Encefálico/complicaciones , Lateralidad Funcional/fisiología , Putamen/patología , Anciano , Amnesia Global Transitoria/diagnóstico por imagen , Infarto Encefálico/diagnóstico por imagen , Femenino , Humanos , Yofetamina/farmacocinética , Imagen por Resonancia Magnética , Putamen/diagnóstico por imagen , Tomografía Computarizada de Emisión de Fotón Único
12.
Clin Auton Res ; 25(3): 189-91, 2015 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-25822581

RESUMEN

We present a case of a 57-year-old female patient with transient global amnesia, who later developed broken heart syndrome also known as takotsubo cardiomyopathy. The present case underlines that co-occurrence of both pathologies might still be an under-recognized clinical problem.


Asunto(s)
Amnesia Global Transitoria/patología , Cardiomiopatía de Takotsubo/patología , Síndrome Coronario Agudo/diagnóstico , Síndrome Coronario Agudo/fisiopatología , Amnesia Global Transitoria/complicaciones , Ecocardiografía , Electrocardiografía , Femenino , Humanos , Persona de Mediana Edad , Examen Neurológico , Pruebas Neuropsicológicas , Cardiomiopatía de Takotsubo/complicaciones , Resultado del Tratamiento
13.
Neurol Neurochir Pol ; 48(5): 337-41, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-25440012

RESUMEN

BACKGROUND: The main hypotheses regarding mechanisms of transient global amnesia (TGA) are ischemia in hippocampal structures, epileptic genesis, and migraine. In accordance with the hypothesis of a shared, common pathophysiological mechanism in both TGA and migraine, neuromuscular transmission (NMT) abnormalities previously found in migraine were also suspected in TGA. OBJECTIVE: The aim of our study was to analyze NMT in TGA patients to reveal a subclinical impairment of neuromuscular transmission as a possible indicator of underlying channelopathy, which would point to a shared etiology with migraine. MATERIALS AND METHODS: The study group consisted of 15 patients (6 males) with TGA (mean age 69.5±7.4yrs). The duration of amnesia ranged from 1 to 6h (mean 4.4h). Single fiber electromyography (SFEMG), the most sensitive tool for NMT assessment, of the voluntarily activated frontal muscle was performed 1-5 days after a TGA incident. RESULTS: Abnormal SFEMG was found in 1 patient (6.6%). In all other patients, SFEMG was in the normal range. CONCLUSION: Our neurophysiological study does not confirm NMT defects in TGA. The role of channelopathy with NMT dysfunction in the pathogenesis of TGA is rather unlikely, whereas subclinical NMT abnormalities were certainly proven in migraine.


Asunto(s)
Amnesia Global Transitoria/complicaciones , Enfermedades Neuromusculares/etiología , Enfermedades Neuromusculares/patología , Unión Neuromuscular/fisiopatología , Anciano , Anciano de 80 o más Años , Electromiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Tiempo
14.
Epilepsy Behav ; 36: 41-6, 2014 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-24857807

RESUMEN

Mild cognitive impairment (MCI) converts to Alzheimer's disease within a few years of diagnosis in up to 80% of patients. The identification among such a population of a rare form of epilepsy (transient epileptic amnesia [TEA]), characterized by mixed anterograde and retrograde amnesia with apparent preservation of other cognitive functions, excessively rapid decay of newly acquired memories, and loss of memories for salient personal events of the remote past, strongly affects prognosis and medical treatment. Our aim was to define the clinical utility of routine high-density electroencephalography (EEG) in patients with MCI for the detection of epilepsy, especially TEA. Using high-density EEG (256 channels), we were able to single out 3 cases of TEA previously misdiagnosed as MCI in this cohort of 76 consecutive patients with MCI diagnosed at our center. Antiepileptic treatment effectively stopped the acute episodes of memory loss. To our knowledge, this is the first report of an incidence of 4% of TEA recorded in such a cohort.


Asunto(s)
Amnesia Global Transitoria/complicaciones , Amnesia Global Transitoria/diagnóstico , Ondas Encefálicas/fisiología , Disfunción Cognitiva/fisiopatología , Electroencefalografía , Epilepsia/complicaciones , Epilepsia/diagnóstico , Anciano , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Pruebas Neuropsicológicas
19.
Arch Neurol ; 69(3): 401-4, 2012 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-22410450

RESUMEN

OBJECTIVE: To describe 3 patients with a history of transient global amnesia (TGA) who developed primary progressive aphasia (PPA). DESIGN: Case series. SETTING: Tertiary care center. PATIENTS: The study included 3 patients who presented to the neurology clinic with language complaints. MAIN OUTCOME MEASURE: Presence of recurrent TGA and PPA. RESULTS: Three patients with a history of TGA were subsequently diagnosed as having PPA. All patients had recurrent attacks of TGA. The diagnoses of PPA were supported by speech pathology evaluations, neuropsychometric testing results, and imaging findings. Positron emission tomography revealed left posterior frontal hypometabolism in 1 patient and predominantly left temporal parietal hypometabolism in 1 patient, while single-photon emission computed tomography demonstrated decreased perfusion in the anterior left temporal and frontal lobes in the third patient. CONCLUSION: There may be a relationship between recurrent TGA and the development of PPA.


Asunto(s)
Amnesia Global Transitoria/complicaciones , Afasia Progresiva Primaria/etiología , Anciano , Amnesia Global Transitoria/clasificación , Amnesia Global Transitoria/psicología , Afasia Progresiva Primaria/clasificación , Afasia Progresiva Primaria/psicología , Atrofia , Corteza Cerebral/fisiopatología , Trastornos del Conocimiento/etiología , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Recurrencia
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