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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.
Neurocrit Care ; 30(1): 171-176, 2019 02.
Artículo en Inglés | MEDLINE | ID: mdl-30094686

RESUMEN

BACKGROUND: Case series have reported reversible left ventricular dysfunction, also known as stress cardiomyopathy or Takotsubo cardiomyopathy (TCM), in the setting of acute neurological diseases such as subarachnoid hemorrhage. The relative associations between various neurological diseases and Takotsubo remain incompletely understood. METHODS: We performed a cross-sectional study of all adults in the National Inpatient Sample, a nationally representative sample of US hospitalizations, from 2006 to 2014. Our exposures of interest were primary diagnoses of acute neurological disease, defined by ICD-9-CM diagnosis codes. Our outcome was a diagnosis of TCM. Binary logistic regression models were used to examine the associations between our pre-specified neurological diagnoses and TCM after adjustment for demographics. RESULTS: Among acute neurological diagnoses, the strongest associations were seen with subarachnoid hemorrhage (odds ratio [OR] 11.7; 95% confidence interval [CI] 10.2-13.4), status epilepticus (OR 4.9; 95% CI 3.7-6.3), and seizures (OR 1.3; 95% CI 1.1-1.5). In a sensitivity analysis including secondary diagnoses of acute neurological diagnoses, associations were also seen with transient global amnesia (OR 2.3; 95% CI 1.5-3.6), meningoencephalitis (OR 2.1; 95% CI 1.7-2.5), migraine (OR 1.7; 95% CI 1.5-1.8), intracerebral hemorrhage (OR 1.3; 95% CI 1.1-1.5), and ischemic stroke (OR 1.2; 95% CI 1.1-1.3). In addition, female sex was strongly associated with Takotsubo (OR 5.1; 95% CI 4.9-5.4). CONCLUSION: TCM appears to be associated with varying degrees with several acute neurological diseases besides subarachnoid hemorrhage.


Asunto(s)
Amnesia Global Transitoria/epidemiología , Isquemia Encefálica/epidemiología , Hemorragia Cerebral/epidemiología , Meningoencefalitis/epidemiología , Convulsiones/epidemiología , Accidente Cerebrovascular/epidemiología , Hemorragia Subaracnoidea/epidemiología , Cardiomiopatía de Takotsubo/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Comorbilidad , Estudios Transversales , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Factores Sexuales , Estado Epiléptico/epidemiología , Estados Unidos/epidemiología , Adulto Joven
3.
Epilepsy Behav ; 88: 205-211, 2018 11.
Artículo en Inglés | MEDLINE | ID: mdl-30296664

RESUMEN

OBJECTIVE: Transient epileptic amnesia (TEA) is an underestimated condition in emergency clinical setting, where most of transient amnesic episodes tend to be classified as transient global amnesia (TGA). We designed this study to evaluate the actual frequency of TEA in a real-life scenario and to highlight the features that can help clinicians distinguishing it from TGA. METHODS: We retrospectively collected clinical data of 83 patients who accessed our emergency ward for an abrupt onset of amnesic disorder, initially interpreted as TGA. All patients underwent neurological evaluation, magnetic resonance imaging (MRI) scan, and standard 21-channel scalp electroencephalography (EEG) recording (standard EEG [st-EEG]). Moreover, patients with borderline epileptiform abnormalities on st-EEG or with normal st-EEG but high clinical suspicion for TEA underwent a 16-channel 24-hour ambulatory EEG (24-h EEG). Clinical features, neurophysiological, and neuroimaging data were analyzed and compared in the two groups (TEA and TGA). RESULTS: Diagnosis of TEA, according to Zeman's criteria, was made in 15 patients (18%). From a clinical point of view recurrence (p < .001) and atypical symptoms such as confusion or language disorder (TGA plus manifestations), appear to be key elements in order to discriminate between TEA and TGA (80% of patients with TEA vs 7.8% of patients with TGA; p < .001). In our sample, duration of the episodes did not significantly differ between TGA and TEA, even though it is usually described as shorter for TEA. This result could be related with a prolonged postictal state in these patients. The analysis of st-EEG results evidenced low sensitivity for interictal epileptiform abnormalities (IEAs) detection (52.3%), with not conclusive data in distinguishing TEA from TGA. On the contrary, 24-h EEG showed IEAs in all patients with epilepsy, mostly during sleep, suggesting an essential diagnostic role of long-lasting EEG recording for TEA. Finally, structural abnormalities were more frequent in patients with TEA (26.6%). In the group with TGA, the only imaging alteration found was diffusion weighted imaging (DWI) hippocampal hyperintensity. CONCLUSION: Our findings show that in a real-life clinical scenario, TEA is frequent but often overlooked. However, simple clinical data and widely available neurophysiological examinations can truly help to effectively distinguish TEA from TGA.


Asunto(s)
Amnesia Anterógrada/diagnóstico , Amnesia Global Transitoria/diagnóstico , Epilepsia/diagnóstico , Adulto , Anciano , Amnesia Anterógrada/epidemiología , Amnesia Global Transitoria/epidemiología , Diagnóstico Diferencial , Electroencefalografía , Epilepsia/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Neuroimagen , Estudios Retrospectivos
4.
Eur Neurol ; 80(1-2): 42-49, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30205365

RESUMEN

BACKGROUND: Transient global amnesia (TGA) is an interesting clinical syndrome characterized by sudden memory loss for recent events and an inability to retain new memories usually lasting several hours and recovering spontaneously. We conducted a literature search of medical procedure-related TGA and its predisposing conditions. METHODS: We performed PubMed searches using the keyword "transient global amnesia" combined with "procedure," "test," "therapy," or various other individual medical procedures. In addition, we described 2 cases of gastroscopy-related TGA. RESULTS: Eighty-nine patients with medical procedure-related TGA in 49 articles were summarized. The most common procedure was cerebral angiography (n = 45), followed by coronary angiography (n = 10) and general anesthesia (n = 9). After categorization, neurological procedures were most common (n = 46, 51.7%), followed by cardiac (n = 17, 19.1%), anesthetic (n = 11, 12.4%), gastrointestinal (n = 4, 4.5%), and pulmonary (n = 2, 2.2%) procedures. CONCLUSIONS: Diverse cases of medical procedure-related TGA have been reported in the literature. Valsalva-associated activities, emotional stress with anxiety, and acute pain were predisposing conditions. An understanding of medical procedure-related TGA may be important for clinicians who perform such medical procedures.


Asunto(s)
Amnesia Global Transitoria/etiología , Técnicas y Procedimientos Diagnósticos/efectos adversos , Procedimientos Quirúrgicos Operativos/efectos adversos , Adulto , Amnesia Global Transitoria/epidemiología , Ansiedad/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad
5.
Stroke ; 48(8): 2270-2273, 2017 08.
Artículo en Inglés | MEDLINE | ID: mdl-28584000

RESUMEN

BACKGROUND AND PURPOSE: We aimed to describe the frequency and characteristics of acute ischemic stroke and transient ischemic attacks presenting predominantly with amnesia (ischemic amnesia) and to identify clinical clues for differentiating them from transient global amnesia (TGA). METHODS: We retrospectively analyzed and described all patients presenting with diffusion-weighted imaging magnetic resonance imaging-confirmed acute ischemic stroke/transient ischemic attacks with antero- and retrograde amnesia as the main symptom over a 13.5-year period. We also compared their clinical features and stroke mechanisms with 3804 acute ischemic stroke from our ischemic stroke registry. RESULTS: Thirteen ischemic amnesia patients were identified, representing 0.2% of all patients with acute ischemic stroke/transient ischemic attack. In 69% of ischemic amnesia cases, amnesia was transient with a median duration of 5 hours. Ischemia was not considered in 39% of cases. Fifty-four percent of cases were clinically difficult to distinguish from TGA, including 15% who were indistinguishable from TGA. 1.2% of all presumed TGA patients at our center were later found to have ischemic amnesia. Amnesic strokes were more often cardioembolic, multiterritorial, and typically involved the posterior circulation and limbic system. Clinical clues were minor focal neurological signs, higher age, more risk factors, and stroke favoring circumstances. Although all patients were independent at 3 months, 31% had persistent memory problems. CONCLUSIONS: Amnesia as the main symptom of acute ischemic cerebral events is rare, mostly transient, and easily mistaken for TGA. Although clinical clues are often present, the threshold for performing diffusion-weighted imaging in acute amnesia should be low.


Asunto(s)
Amnesia Global Transitoria/diagnóstico por imagen , Imagen de Difusión por Resonancia Magnética/tendencias , Ataque Isquémico Transitorio/diagnóstico por imagen , Amnesia Global Transitoria/epidemiología , Estudios de Seguimiento , Humanos , Ataque Isquémico Transitorio/epidemiología , Estudios Prospectivos , Sistema de Registros , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento
6.
Sleep Med ; 32: 36-39, 2017 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-28366339

RESUMEN

OBJECTIVE: The etiology of transient global amnesia (TGA) is largely undetermined. The aim of this study was to investigate whether the prevalence of obstructive sleep apnea syndrome (OSAS), a condition associated with subtle changes in brain structures involved in memory processes, increases in subjects who have previously experienced a TGA episode. METHODS: Twenty-nine patients who had had a TGA episode were included. A case-control model was used, matching cases with controls by sex, age, and body mass index category. Diagnosis of OSAS was based on the results of the Berlin Questionnaire, which was later confirmed by means of an all-night polysomnography recording. RESULTS: The prevalence of OSAS among TGA patients was significantly higher with respect to that in controls (44.8% vs 13.8%, p = 0.020, χ2 test). At logistic regression model, subjects with TGA had an odds ratio of 8.409 (95% confidence interval = 1.674-42.243; p = 0.010) of having OSAS when compared with controls. CONCLUSIONS: According to our findings, an accurate investigation of sleep disturbances could be considered for a complete assessment of patients with TGA. The subtle cerebral anatomo-functional damage induced by the repeated nocturnal apneic episodes may be a pathophysiologic link between OSAS and TGA.


Asunto(s)
Amnesia Global Transitoria/etiología , Apnea Obstructiva del Sueño/epidemiología , Adulto , Anciano , Amnesia Global Transitoria/epidemiología , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Apnea Obstructiva del Sueño/complicaciones
7.
Mayo Clin Proc ; 92(3): 399-405, 2017 03.
Artículo en Inglés | MEDLINE | ID: mdl-28185658

RESUMEN

OBJECTIVE: To study the long-term risk of cerebrovascular events, seizures, and cognitive impairment in patients with transient global amnesia (TGA). PATIENTS AND METHODS: Data for all patients diagnosed with possible TGA in Olmsted County, Minnesota, between January 1, 1985, through December 31, 2010, were retrieved from the Rochester Epidemiology Project database. Transient global amnesia was defined clinically. End points were cerebrovascular event (stroke or transient ischemic attack), seizure, or cognitive impairment (mild cognitive impairment or dementia) during follow-up. End points were studied using Kaplan-Meier survival plots and log-rank test. RESULTS: A total of 221 patients with TGA were identified and 221 age- and sex-matched controls were included in the analysis. The mean duration of follow-up was 12 years in both groups (range, 0.07-29.93). Prevalence of vascular risk factors and history of seizures were similar between both groups. Previous migraine was more common in the TGA group (42 patients [19.1%] vs 12 patients [5.4%]; P<.001). There was no statistically significant difference between survival curves for the TGA group and the control group using time to any type of cerebrovascular event (log-rank P=.30), time to seizures event (log-rank P=.55), and time to cognitive impair event (log-rank P=.88) as end points. The TGA recurrence occurred in 5.4% of patients after a median interval of 4.21 years (interquartile range, 2.82-8.44). Modified Rankin scale and death rates at last follow-up were also similar between both groups. CONCLUSION: Our findings indicate that having an episode of TGA does not increase the risk of subsequent cerebrovascular events, seizures, or cognitive impairment.


Asunto(s)
Amnesia Global Transitoria/epidemiología , Trastornos del Conocimiento/epidemiología , Ataque Isquémico Transitorio/epidemiología , Convulsiones/epidemiología , Accidente Cerebrovascular/epidemiología , Anciano , Estudios de Casos y Controles , Comorbilidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Minnesota/epidemiología , Vigilancia de la Población/métodos , Prevalencia , Medición de Riesgo/métodos
8.
J Neurol Neurosurg Psychiatry ; 87(4): 363-6, 2016 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-25855400

RESUMEN

OBJECTIVE: To estimate the hospital revisit rate of patients diagnosed with conversion disorder (CD). METHODS: Using administrative data, we identified all patients discharged from California, Florida and New York emergency departments (EDs) and acute care hospitals between 2005 and 2011 with a primary discharge diagnosis of CD. Patients discharged with a primary diagnosis of seizure or transient global amnesia (TGA) served as control groups. Our primary outcome was the rate of repeat ED visits and hospital admissions after initial presentation. Poisson regression was used to compare rates between diagnosis groups while adjusting for demographic characteristics. RESULTS: We identified 7946 patients discharged with a primary diagnosis of CD. During a mean follow-up of 3.0 (±1.6) years, patients with CD had a median of three (IQR, 1-9) ED or inpatient revisits, compared with 0 (IQR, 0-2) in patients with TGA and 3 (IQR, 1-7) in those with seizures. Revisit rates were 18.25 (95% CI, 18.10 to 18.40) visits per 100 patients per month in those with CD, 3.90 (95% CI, 3.84 to 3.95) in those with TGA and 17.78 (95% CI, 17.75 to 17.81) in those with seizures. As compared to CD, the incidence rate ratio for repeat ED visits or hospitalisations was 0.89 (95% CI, 0.86 to 0.93) for seizure disorder and 0.32 (95% CI 0.31 to 0.34) for TGA. CONCLUSIONS: CD is associated with a substantial hospital revisit rate. Our findings suggest that CD is not an acute, time-limited response to stress, but rather that CD is a manifestation of a broader pattern of chronic neuropsychiatric disease.


Asunto(s)
Trastornos de Conversión/epidemiología , Readmisión del Paciente/estadística & datos numéricos , Adulto , Amnesia Global Transitoria/epidemiología , Trastornos de Conversión/terapia , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Estudios de Seguimiento , Hospitalización/estadística & datos numéricos , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Alta del Paciente , Distribución de Poisson , Convulsiones/epidemiología , Resultado del Tratamiento , Estados Unidos/epidemiología
9.
Rev Neurol (Paris) ; 171(8-9): 662-8, 2015 Sep.
Artículo en Francés | MEDLINE | ID: mdl-26239061

RESUMEN

INTRODUCTION: According to the criteria of Hodges and Warlow, transient global amnesia is defined by sudden onset of isolated anterograde amnesia of spontaneous resolution within one to twenty-four hours. Its pathophysiological mechanisms are still uncertain. METHODS: In a retrospective study, we have analyzed epidemiological, clinical and MRI data from twelve patients admitted to the only neurological department of French Polynesia for transient global amnesia corresponding to the criteria of Hodges and Warlow between January 2010 and December 2013. RESULTS: The median age of the cohort was 61.5 (53-72), the sex ratio was 1. Ten patients had one or more cardiovascular risk factors, 3 had migraine headaches and 3 had anxiodepressive disorders. Among triggers found, the occurrence during the rest was noted in one case. Retrograde amnesia was observed in 42% of cases, repetitive questioning in 75% of cases, anxious bewilderment in 67% of cases and disorientation in 33% of cases. The median episode duration was 9 hours and the duration of hospitalization was 3 days. Three patients had a recurrence. MRI was abnormal in all patients and showed diffusion-weighted hyperintensities in right (n=8), left (n=3) and bilateral (n=1) hippocampi. CONCLUSION: Epidemiological, clinical and MRI data from our cohort are similar to those from the literature except for the highest prevalence of cardiovascular risk factors and the most frequent right hippocampus involvement. Transient global amnesia occurring exceptionally while sleeping was also observed in one of our patients.


Asunto(s)
Amnesia Global Transitoria/epidemiología , Anciano , Amnesia Global Transitoria/etnología , Amnesia Global Transitoria/patología , Amnesia Global Transitoria/psicología , Trastornos de Ansiedad/epidemiología , Comorbilidad , Confusión/etiología , Trastorno Depresivo/epidemiología , Imagen de Difusión por Resonancia Magnética , Dislipidemias/epidemiología , Femenino , Hipocampo/patología , Humanos , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad , Trastornos Migrañosos/epidemiología , Grupo de Ascendencia Oceánica/psicología , Polinesia/epidemiología , Recurrencia , Estudios Retrospectivos , Factores de Riesgo , Trastornos Intrínsecos del Sueño/etiología , Fumar/epidemiología
10.
Headache ; 55(6): 853-9, 2015 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-25877480

RESUMEN

OBJECTIVE: The etiology of transient global amnesia (TGA) remains unclear, and flow disturbances in the mesial temporal lobes secondary to venous congestion have been proposed as a potential cause. The occurrence of TGA during a migraine attack is a rare condition. METHODS: This 11-year retrospective study in one French center describes patients' characteristics, type of migraine, investigations, treatment with vasoconstrictor during the TGA/migraine attack, and outcome in patients who had TGA during a migraine attack. RESULTS: Among 8821 new patients, 6 cases of TGA occurring during a migraine attack were identified. For a majority of patients, TGA occurs after the beginning of the attack. TGA always occurs during a severe migraine attack, with vomiting or vomiting efforts. Vomiting or vomiting efforts always precede a TGA episode. CONCLUSIONS: TGA occurring during a migraine attack is rare. Since a Valsalva maneuver, such as forceful vomiting, is frequently described at the origin of the attack, blocking venous return through the superior venous cava may allow brief retrograde transmission of high venous pressure from the arms to the cerebral venous system, resulting in venous ischemia to the diencephalon or mesial temporal lobes and causing TGA.


Asunto(s)
Amnesia Global Transitoria/diagnóstico , Amnesia Global Transitoria/etiología , Trastornos Migrañosos/complicaciones , Trastornos Migrañosos/diagnóstico , Centros de Atención Terciaria/tendencias , Adolescente , Adulto , Anciano , Amnesia Global Transitoria/epidemiología , Niño , Femenino , Francia/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Trastornos Migrañosos/epidemiología , Estudios Retrospectivos , Factores de Tiempo
11.
PLoS One ; 10(4): e0122960, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-25849383

RESUMEN

BACKGROUND: Psychological stress has been associated with transient global amnesia (TGA). Whether a cancer diagnosis, a severely stressful life event, is associated with subsequent risk of TGA has not been studied. METHODS: Based on the Swedish Cancer Register and Patient Register, we conducted a prospective cohort study including 5,365,608 Swedes at age 30 and above during 2001-2009 to examine the relative risk of TGA among cancer patients, as compared to cancer-free individuals. Incidence rate ratios (IRRs) and their 95% confidence intervals (CIs) derived from Poisson regression were used as estimates of the association between cancer diagnosis and the risk of TGA. RESULTS: During the study 322,558 individuals (6.01%) received a first diagnosis of cancer. We identified 210 cases of TGA among the cancer patients (incidence rate, 0.22 per 1000 person-years) and 4,887 TGA cases among the cancer-free individuals (incidence rate, 0.12 per 1000 person-years). Overall, after adjustment for age, sex, calendar year, socioeconomic status, education and civil status, cancer patients had no increased risk of TGA than the cancer-free individuals (IRR, 0.99; 95% CI, 0.86-1.13). The IRRs did not differ over time since cancer diagnosis or across individual cancer types. The null association was neither modified by sex, calendar period or age. CONCLUSION: Our study did not provide support for the hypothesis that patients with a new diagnosis of cancer display a higher risk of TGA than cancer-free individuals.


Asunto(s)
Amnesia Global Transitoria/etiología , Neoplasias/psicología , Anciano , Anciano de 80 o más Años , Amnesia Global Transitoria/epidemiología , Estudios de Casos y Controles , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Análisis Multivariante , Neoplasias/diagnóstico , Estudios Prospectivos , Factores de Riesgo
12.
Mayo Clin Proc ; 90(2): 264-72, 2015 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-25659242

RESUMEN

Transient global amnesia (TGA) is a clinical syndrome characterized by the sudden onset of anterograde amnesia (the inability to encode new memories), accompanied by repetitive questioning, sometimes with a retrograde component, lasting up to 24 hours, without compromise of other neurologic functions. Herein, we review current knowledge on the epidemiology, pathophysiology, clinical diagnosis, and prognosis of TGA. For this review, we conducted a literature search of PubMed, with no date limitations, using the following search terms (or combinations of them): transient global amnesia, etiology, pathophysiology, venous hypertension, migraine, magnetic resonance imaging, computed tomography, electroencephalography, prognosis, and outcome. We also reviewed the bibliography cited in the retrieved articles. Transient global amnesia is a clinical diagnosis, and recognition of its characteristic features can avoid unnecessary testing. Several pathophysiologic mechanisms have been proposed (venous insufficiency, arterial ischemia, and migrainous or epileptic phenomena), but none of them has been proved to consistently explain cases of TGA. Brain imaging may be considered and electroencephalography is recommended when episodes are brief and recurrent, but otherwise no investigations are necessary in most cases. Data on long-term prognosis are limited, but available information suggests that the relapse rate is low, the risk of stroke and seizures is not considerably increased, and cognitive outcome is generally good.


Asunto(s)
Amnesia Global Transitoria , Amnesia Global Transitoria/diagnóstico , Amnesia Global Transitoria/epidemiología , Amnesia Global Transitoria/fisiopatología , Humanos
13.
Acta Neurol Belg ; 114(4): 293-6, 2014 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-24515914

RESUMEN

Few community-based studies determined the incidence of transient global amnesia (TGA), with annual incidence rates between 2.9 and 10.4/100,000. Data on sex distribution of TGA are discrepant. Aim of this study was to determine the incidence of TGA in Merano, province of Bolzano, Northern Italy. Cases were identified from hospital discharge diagnoses of all the Departments of the general hospital of Merano and neighboring towns. Patients fulfilling internationally accepted diagnostic criteria for TGA and residing in Merano were included. Crude, age- and sex-specific incidence rates were computed. The overall annual crude incidence rate of TGA was 9.6/100,000 inhabitants (9.5 % confidence interval 6.7-13.3), 10.1/100,000 for men and 8.9/100,000 for women (p < 0.001). After adjustment by the direct method to the European population, the annual incidence rate was 6.4/100,000. The incidence rate of TGA in Merano, Italy, does not differ from that reported in Turku, Finland and Belluno, Italy. This study confirms that this benign syndrome is relatively common and occurs mainly in elderly patients. However, the higher male predominance in TGA incidence rates contrasts with previous epidemiological studies. Further, prospective incidence studies should therefore be conducted to further clarify sex predominance in TGA.


Asunto(s)
Amnesia Global Transitoria/epidemiología , Distribución por Edad , Anciano , Anciano de 80 o más Años , Amnesia Global Transitoria/diagnóstico , Femenino , Humanos , Incidencia , Italia/epidemiología , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Características de la Residencia
14.
Eur J Neurol ; 21(5): 718-24, 2014 May.
Artículo en Inglés | MEDLINE | ID: mdl-24520813

RESUMEN

BACKGROUND AND PURPOSE: The association between migraine and transient global amnesia (TGA) is not determined. Only two clinic-based studies showed that TGA patients had a higher frequency of migraine history. Our population-based study aimed to investigate whether migraine patients were associated with a higher risk of developing TGA. METHODS: Patients with migraine aged ≥18 years were identified from the Taiwan National Health Insurance Research Database between 2005 and 2009. Each migraine patient was randomly matched to one subject without migraine or other headache disorders based on age, sex and cardiovascular comorbidities. Patients with antecedent stroke, epilepsy or TGA were excluded. Both cohorts were followed up until the end of 2010. The incidence rates of TGA were compared and risk factors were identified. RESULTS: A total of 158 301 patients in the migraine cohort and 158 301 patients in the matched control cohort were enrolled. During a mean follow-up of 3.0 years (range 0-6 years), the migraine cohort had a greater risk of developing TGA than the control cohort [7.59 vs. 3.06 per 100 000 person-years, incidence rate ratio (IRR) = 2.48, P = 0.002]. Compared with the matched cohort, only female migraine patients aged 40-60 years showed a significantly higher risk of TGA [IRR = 3.18 (1.31-8.82), P = 0.005]. Of note, the incidence rates did not differ between migraine patients with and without aura. CONCLUSIONS: This population-based study demonstrates that migraine is associated with an increased risk of TGA, particularly in female patients aged 40-60 years.


Asunto(s)
Amnesia Global Transitoria/epidemiología , Trastornos Migrañosos/epidemiología , Adulto , Estudios de Casos y Controles , Estudios de Cohortes , Comorbilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos Migrañosos/clasificación , Trastornos Migrañosos/diagnóstico , Factores de Riesgo , Sensibilidad y Especificidad , Taiwán/epidemiología
15.
Eur Neurol ; 71(1-2): 19-24, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24281363

RESUMEN

BACKGROUND: The pathophysiology of transient global amnesia (TGA) is not fully understood. This study was conducted to identify the cardiovascular risk factors of TGA compared to those of transient ischemic attack (TIA) and normal controls, using a large number of subjects. In addition to the comparison of risk factors, an association between the observed cardiovascular risk factors in the current study and a pathophysiological mechanism recently investigated was speculated upon. MATERIALS AND METHODS: We performed a retrospective case-control study that compared 293 TGA patients to 632 TIA patients and 293 age- and sex-matched normal controls. Demographic details and cardiovascular risk factors were carefully recorded. RESULTS: TGA patients had a significantly higher prevalence of ischemic heart disease and hyperlipidemia; however, they had a lower prevalence of hypertension, diabetes mellitus, ischemic stroke and atrial fibrillation when compared to TIA patients. When compared to age- and sex-matched normal controls, TGA patients also had a significantly higher prevalence of hyperlipidemia, previous ischemic stroke and ischemic heart disease. CONCLUSION: The cardiovascular risk factors identified in TGA patients in this study were different from those of previously reported studies. This disproportionate prevalence of cardiovascular risk factors may constitute possible evidence that TGA and TIA differ in their pathophysiological mechanism. In addition, some cardiovascular risk factors, such as hyperlipidemia and ischemic heart disease, should be regarded as possible risk factors of TGA.


Asunto(s)
Amnesia Global Transitoria/epidemiología , Ataque Isquémico Transitorio/epidemiología , Factores de Edad , Amnesia Global Transitoria/fisiopatología , Enfermedades Cardiovasculares/epidemiología , Estudios de Casos y Controles , Femenino , Humanos , Hiperlipidemias/epidemiología , Ataque Isquémico Transitorio/fisiopatología , Masculino , Persona de Mediana Edad , Análisis Multivariante , Isquemia Miocárdica/epidemiología , Prevalencia , Estudios Prospectivos , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales
16.
Stroke ; 45(2): 389-93, 2014 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-24309586

RESUMEN

BACKGROUND AND PURPOSE: Whether transient global amnesia (TGA) represents an arterial insult that heralds ischemic stroke remains unclear. Therefore, we examined stroke risk after TGA in a population-based cohort. METHODS: After performing chart review at our institution to validate the International Classification of Diseases, 9th Edition, Clinical Modification diagnosis code for TGA, we used administrative claims data to identify all patients discharged from nonfederal California emergency departments or acute care hospitals between 2005 and 2010 with a primary discharge diagnosis of TGA. Patients with a primary discharge diagnosis of migraine, seizure, or transient ischemic attack were included as controls. Kaplan-Meier statistics were used to calculate rates of ischemic stroke, and Cox proportional hazards analyses were used to compare stroke risk among the 4 exposure groups while controlling for traditional stroke risk factors. RESULTS: International Classification of Diseases, 9th Edition, Clinical Modification code 437.7 had a sensitivity of 86% and a specificity of 95% for TGA. The cumulative 1-year rate of stroke was 0.54% (95% confidence interval [CI], 0.36-0.81) after TGA, 0.22% (95% CI, 0.20-0.25) after migraine, 0.90% (95% CI, 0.83-0.97) after seizure, and 4.72% (95% CI, 4.60-4.85) after transient ischemic attack. After adjustment for demographic characteristics and stroke risk factors, TGA was not associated with stroke risk when compared with migraine (hazard ratio, 0.82; 95% CI, 0.61-1.10). The likelihood of stroke after TGA was lower than after seizure (hazard ratio, 0.57; 95% CI, 0.44-0.76) or transient ischemic attack (hazard ratio, 0.27; 95% CI, 0.20-0.35). CONCLUSIONS: Compared with patients diagnosed with migraine or seizure, patients diagnosed with TGA do not seem to face a heightened risk of stroke.


Asunto(s)
Amnesia Global Transitoria/epidemiología , Accidente Cerebrovascular/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , California/epidemiología , Estudios de Cohortes , Intervalos de Confianza , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Clasificación Internacional de Enfermedades , Ataque Isquémico Transitorio/complicaciones , Ataque Isquémico Transitorio/epidemiología , Masculino , Persona de Mediana Edad , Trastornos Migrañosos/complicaciones , Trastornos Migrañosos/epidemiología , Pronóstico , Reproducibilidad de los Resultados , Estudios Retrospectivos , Factores de Riesgo , Convulsiones/complicaciones , Convulsiones/epidemiología , Resultado del Tratamiento
17.
Acta Biomed ; 85(3): 229-35, 2014 Dec 17.
Artículo en Inglés | MEDLINE | ID: mdl-25567459

RESUMEN

Transient Global Amnesia (TGA) is a clinical syndrome characterized by temporary inability to form new memories described as anterograde amnesia. It is associated with retrograde amnesia and repetitive questioning. During the attack patients remain conscious and communicative and personal identity is preserved. Focal neurological symptoms and epileptic features are absent and general conditions appear intact. The ability to store new memories gradually recovers and subjects return to normal conditions except for a substantial amnestic gap for the duration of the attack. TGA has an incidence of 3-8 per 100 000 people per year. It usually affects patients between the ages of 50 and 70 years, at an average age of 61 years; occurrence in patients younger than 40 years of age is rare. The rate of recurrence is between 6% and 10% per years. No gender prevalence has been recorded. The patients with definite TGA have a very good prognosis; their rate of subsequent major vascular events is less than 1% per year.


Asunto(s)
Amnesia Global Transitoria , Memoria/fisiología , Amnesia Global Transitoria/diagnóstico , Amnesia Global Transitoria/epidemiología , Amnesia Global Transitoria/fisiopatología , Diagnóstico Diferencial , Salud Global , Humanos , Incidencia , Pronóstico , Psicometría/métodos , Recurrencia
18.
J Neuroimaging ; 24(4): 331-7, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-23551898

RESUMEN

BACKGROUND AND PURPOSE: The detection rate of typical transient global amnesia (TGA) lesions on diffusion-weighted imaging (DWI) can be improved, up to 85% with optimal DWI parameters and imaging time. There is limited evidence that these findings are similar to those observed in large-scale consecutive patients with TGA in clinical practice. METHODS: Patients with clinically diagnosed TGA underwent magnetic resonance imaging studies, consecutively, with three sets of DWI parameters (standard clinical DWI protocols, the TGA DWI protocol I and the TGA DWI protocol II) in which the resolution, slice thickness, and the time interval between symptom onset of DWI were varied over an 8-year period. RESULTS: TGA lesion detection rates were up to 88% with a modified TGA DWI protocol. The lesion detection rate was the highest using TGA DWI protocol I, with b = 3,000 s/mm(2), a slice thickness of 3 mm, and performed on the third day after symptom onset, and TGA DWI protocol II, with b = 2,000 s/mm(2) and a slice thickness of 2 mm. CONCLUSIONS: A modified TGA DWI protocols for detecting TGA lesions are useful in large-scale clinical practice for confirming the diagnosis of TGA patients with clinical findings.


Asunto(s)
Algoritmos , Amnesia Global Transitoria/epidemiología , Amnesia Global Transitoria/patología , Imagen de Difusión por Resonancia Magnética/estadística & datos numéricos , Aumento de la Imagen/métodos , Interpretación de Imagen Asistida por Computador/métodos , Sistema de Registros , Adulto , Anciano , Anciano de 80 o más Años , Imagen de Difusión por Resonancia Magnética/métodos , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Prevalencia , Reproducibilidad de los Resultados , República de Corea/epidemiología , Factores de Riesgo , Sensibilidad y Especificidad
19.
J Headache Pain ; 14: 52, 2013 Jun 19.
Artículo en Inglés | MEDLINE | ID: mdl-23782952

RESUMEN

BACKGROUND: Migraine with aura is associated with patent foramen ovale and right-left-shunt. Jugular venous valve insufficiency is a further vascular anomaly. It is a frequent finding in transient global amnesia which is associated with migraine. Therefore, we investigated the prevalence of jugular venous valve insufficiency in migraine. METHODS: Subjects included in this study were participants of the population based German Headache Study on the prevalence of primary headaches. In 36 patients with migraine with aura, 50 patients with migraine without aura and 43 controls without headaches duration of backward venous flow, peak velocity flow and diameters of the jugular venous valves were assessed by color-coded duplex and Doppler sonography and compared between groups. In all migraine patients, examination was performed between and not during migraine attacks. Therefore, 9 additional patients with chronic daily headache were investigated during headache. RESULTS: We did not find statistically significant differences in duration of flow, peak velocity flow and diameter of the jugular venous valves in patients with migraine with aura (mean values 0.53 ± 0.43 sec; 35.47 ± 33.87 cm/sec; 8.84 ± 3.17 mm), migraine without aura (0.61 ± 0.63 sec; 33.39 ± 25.80 cm/sec; 8.15 ± 3.02 mm) or controls (0.64 ± 0.51 sec; 35.28 ± 31.76 cm/sec; 8.79 ± 2.97 mm) (group effects p-values >0.41). For all parameters results were the same for the left and the right side of jugular venae (side effects p-values >0.09). Also patients with chronic daily migraine with headache during the examination showed no differences to controls (0.52 ± 0.49 sec; 27.95 ± 21,75 cm/sec; 8.07 ± 2.71 mm) (all p-values > 0.23). CONCLUSIONS: The prevalence of internal jugular venous valve insufficiency is not increased in persons with migraine.


Asunto(s)
Venas Yugulares/fisiopatología , Migraña con Aura/fisiopatología , Migraña sin Aura/fisiopatología , Insuficiencia Venosa/fisiopatología , Adulto , Anciano , Amnesia Global Transitoria/diagnóstico por imagen , Amnesia Global Transitoria/epidemiología , Amnesia Global Transitoria/fisiopatología , Estudios de Casos y Controles , Femenino , Alemania/epidemiología , Humanos , Venas Yugulares/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Migraña con Aura/diagnóstico por imagen , Migraña con Aura/epidemiología , Migraña sin Aura/diagnóstico por imagen , Migraña sin Aura/epidemiología , Encuestas y Cuestionarios , Ultrasonografía , Insuficiencia Venosa/diagnóstico por imagen , Insuficiencia Venosa/epidemiología
20.
Nat Rev Neurol ; 9(2): 86-97, 2013 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-23296343

RESUMEN

Transient amnesic syndromes are striking clinical phenomena that are commonly encountered by physicians in acute medical settings. Diagnosis of such syndromes can be challenging, and their causes have been debated for over 50 years. Critical clinical distinctions, such as between transient global amnesia (TGA) and transient epileptic amnesia (TEA), as well as important clues to the underlying pathophysiology, have recently been revealed. TGA is characterized by the sudden onset of a profound anterograde and retrograde amnesia that lasts for up to 24 h, with neuroimaging after an acute TGA event showing transient perturbation of specific hippocampal circuits that are involved in memory processing. Some cases of transient amnesia are attributable to focal seizure activity and are termed TEA, which has a clinical presentation similar to that of TGA, but can be distinguished from the latter by the brevity and frequency of amnesic attacks. Moreover, TEA carries a risk of persistent memory impairment that can be mistaken for dementia. Here, we summarize clinically relevant aspects of transient amnesic syndromes, giving practical recommendations for diagnosis and patient management. We describe results from imaging and epidemiological studies that have shed light on the functional anatomy and pathophysiological mechanisms underlying these conditions.


Asunto(s)
Amnesia Global Transitoria/patología , Anciano , Amnesia Global Transitoria/epidemiología , Amnesia Global Transitoria/etiología , Amnesia Global Transitoria/psicología , Cognición/fisiología , Epilepsia/complicaciones , Epilepsia/psicología , Femenino , Humanos , Masculino , Memoria/fisiología , Persona de Mediana Edad , Red Nerviosa/patología , Red Nerviosa/fisiología , Sistema Nervioso/anatomía & histología , Sistema Nervioso/patología , Neuroanatomía , Neuroimagen , Pruebas Neuropsicológicas , Accidente Cerebrovascular/complicaciones , Resultado del Tratamiento
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