[Transient global amnesia - benign memory blackout]. / Transiente globale Amnesie ­ gutartiger "Blackout" im Gedächtnis.

Transient global amnesia (TGA) is a typical clinical syndrome characterized by acute, predominantly anterograde amnesia. New epidemiological data assume a significantly higher annual incidence than previously assumed, namely around 15 cases per 100,000 people. Those affected, usually over the age of 50, cannot remember new memory content for longer than 30-180 seconds and therefore ask repetitive questions about current events. All other cognitive functions are unimpaired, and everything previously learnt, e.g. driving or cooking, can be carried out. The episodes are self-limiting and by definition subside within 24 hours. At least 10% of those affected will experience 1-5 recurrences in the future. The punctate lesions in the hippocampus, which are found on MRI in at least 50% of patients after 24-72 hours, are distributed 2/3 unilaterally and 1/3 bilaterally. Using 7 Tesla MRI the frequency of detected lesions increases to 90% compared to 50% with 1.5 or 3 Tesla. Beyond the punctiform hippocampal lesions, other memory-related network disorders, including the default network, are also suggested to be involved in the pathomechanism of TGA. TGA etiology and pathophysiology are not known in detail. Vascular, migraine-like, epilepsy-like, and psychogenic mechanisms are discussed. Triggers of the episodes are often physical exertion with a Valsalva character. Management is aimed at identifying the syndrome based on the typical clinical presentation and ruling out possible differential diagnoses with similar symptoms. During the TGA, the usually anxious relatives should be reassured of the benign and inconsequential nature of the episode.

Transient global amnesia and hippocampal diffusion restriction: an overlooked radiological finding.

Transient global amnesia (TGA) is characterized by isolated sudden anterograde amnesia. Diffusion restriction can be observed in the hippocampus on DWI-MRI at varying rates in TGA patients. This study analyzes the prevalence and characteristics of the hippocampal diffusion restriction (HDR), its relationship with vascular risk factors, and the prevalence of lesions overlooked in routine reports. 91 patients diagnosed with TGA at a tertiary hospital between 2011 and 2022 were evaluated retrospectively. The mean age was 64.8 ± 7.3 years, and 63.7% of patients were female. 75.8% of the patients had at least one vascular risk factor. Focal diffusion restriction was detected in 17 patients (18.5%) on DWI-MRI, with only one being extra-hippocampal. 81.2% of HDR was detected when DWI-MRI scan was performed between 12 and 96 h after the onset of symptoms. HDR was detected most when the imaging was performed in 24 to 48 h (p = 0.03). There was no correlation between the duration of symptoms and the detection rates of HDR (p = 0.55). In 9 patients (53% of 17) diffusion restriction was not specified in routine radiology reports. Although focal ischemia, venous flow abnormalities, migraine and epileptic phenomena have been suggested in its etiology, TGA is a clinical condition of which pathophysiology has not been determined clearly. Signal changes observed in DWI-MRI has led to discussions that cerebrovascular etiology may play a role, yet more comprehensive studies are required to prevent and manage TGA. HDRs can be overlooked in routine reports. Therefore, the DWI-MRI images of patients with TGA should be examined vigilantly.

Transient global amnesia: clinical features and prognostic factors suggesting recurrence / Amnesia global transitoria: características clínicas y factores pronósticos sugestivos de recurrencia

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.

Amnesia global transitoria poscoital recurrente / Recurrent post-coital transient global amnesia

No disponible

No disponible

Actividad sexual como factor desencadenante de amnesia global transitoria / Sexual intercourse as a trigger of transient global amnesia

Introducción. La amnesia global transitoria (AGT) es un trastorno caracterizado por una alteración de la memoriaanterógrada con cierto componente retrógrado, asociado a leve desorientación temporoespacial que se resuelve por completo en un período de unas horas. Existen distintas hipótesis sobre su patogenia, entre las que se incluyen teorías sobre una posible base epiléptica, migrañosa, isquémica o por congestión venosa de los hipocampos, aunque la causa todavía se desconoce. De la misma forma, son muchos los desencadenantes que se han relacionado con este trastorno, entre los que se incluyenel dolor, la ansiedad, los cambios de temperatura, el ejercicio, las maniobras de Valsalva, las pruebas diagnósticas, el intervencionismo y los vuelos transoceánicos. El coito se ha relacionado también con este cuadro clínico, aunque no se conoce cómo puede influir y los casos descritos son todavía escasos en la bibliografía. Casos clínicos. Seis pacientes que sufrieron uncuadro de AGT en clara relación con una relación sexual, en los cuales tanto la exploración neurológica como las pruebas complementarias realizadas fueron rigurosamente normales y recogemos la evidencia a favor y en contra de la asociación entre el coito y esta patología. Conclusiones. Aunque no se conocen los mecanismos fisiopatológicos que relacionan el coito y la AGT, estas dos entidades aparecen relacionadas cada vez con más frecuencia en la bibliografía. Alertamos de la necesidadde tener en cuenta la actividad sexual como un posible factor desencadenante en los pacientes que sufren este trastorno

Introduction. Transient global amnesia (TGA) is characterised by impairment of anterograde memory and, to a certain extent, retrograde memory, which is associated with mild temporal and spatial disorientation that is completely re-established after a few hours. There are different hypotheses about its pathogenesis, including theories about a possible epileptic,migrainous or ischaemic foundation or its being due to venous congestion in the hippocampuses, although the cause remains unknown. In the same way, many precipitating factors have been related to this disorder, including pain, anxiety, changes intemperature, exercise, Valsalva manoeuvres, diagnostic testing, interventionism and long-distance flights. Sexual intercourse has also been related to this condition, although how it can exert an influence is not known and few cases have been reported in the literature to date. Case reports. Six patients who suffered from signs and symptoms of TGA that were clearly related to asexual relationship, in whom both the neurological examination and the complementary tests that were performed were completely normal. We also gather the evidence in favour and against the association between intercourse and this condition.Conclusions. Although the pathophysiological mechanisms that link sexual intercourse with TGA are unknown, the relation between them appears increasingly more often in the literature. We draw attention to the need to take sexual activity into account as a possible precipitating factor in patients suffering from this disorder

Amnesia global transitoria: una revisión. I. Aspectos clínicos / Transient global amnesia: a review. I. Clinical aspects

La amnesia global transitoria (AGT) es un síndrome neuropsicológico en el que se produce una pérdidaabrupta y pasajera de la capacidad para crear nuevos recuerdos, así como una amnesia retrógrada de intensidad variable, mientras que la conciencia, la identidad personal y la atención permanecen preservadas. Objetivo. Revisar los diferentes aspectos clínicos relativos a la AGT. Desarrollo. Se analizan los siguientes temas: su definición y criterios diagnósticos, quéotro tipo de amnesias se deben descartar y cuáles son sus peculiaridades y diferencias con la AGT, datos epidemiológicos, como su incidencia, edad, sexo, nivel educativo de los pacientes y el número de episodios que se suelen dar, cuáles son los escenariosmás frecuentes en los que aparece la AGT y los sucesos desencadenantes habituales. Además, se revisarán las propuestas clásicas sobre su posible etiología (epilepsia, enfermedad cerebrovascular y migraña) y otras nuevas teorías (el fenómeno de la depresión propagada de Leao o la influencia del estrés). Por último, se revisan los diferentes datos de los que se dispone sobre estudios de neuroimagen en pacientes con AGT. Conclusión. Las diferentes hipótesis revisadas sobre la etiología de la AGT cuentan con datos y argumentos a favor y en contra, aunque todavía no existe consenso en torno a una teoría que expliquesatisfactoriamente la naturaleza de este tipo de amnesia

Transient global amnesia (TGA) is a neuropsychological syndrome in which a sudden, temporary lossof the capacity of creating new memories and a retrograde amnesia of variable intensity occur, whereas consciousness, personal identity and attention are preserved. Aim. To review different clinical aspects about TGA. Development. Accordingly, the following topics will be reviewed: definition and diagnosis criteria, types of amnesias which should be ruled out and their peculiarities and differences with TGA, epidemiological data such as incidence, age, sex, educational level of the patients and number of TGA episodes, most frequent scene where TGA appears, and most common triggering events. Additionally,classical proposals about its possible etiology (epilepsy, vascular disease and migraine) and other new theories (Leao’s spreading depression or influence of stress) will be revised. Finally, different data about neuroimaging studies in patients with TGA will be reviewed. Conclusions. There are data and arguments in favour and against the hypotheses regarding etiology of TGA, but there is no current consensus on a theory which explains in a satisfactory way the nature of this kind of amnesia

Amnesia global transitoria durante el coito / Transient global amnesia during sexual intercourse

No disponible

No disponible

Causas vasculares de amnesia global transitoria / Vascular causes of transient global amnesia

No disponible

Respuesta. Causas vasculares de amnesia global transitoria / Reply. Vascular causes of transient global amnesia

No disponible

La policitemia como factor predisponente de amnesia global transitoria / Policithaemia as a ready factor of transitory global amnesia

La amnesia global transitoria (AGT) es un trastorno de memoria anterógrada de inicio brusco y de una duración inferior a 24 h que se ha relacionado con causas isquémicas, comiciales y migrañosas. Por otro lado, la policitemia está clasificada como un trastorno protrombótico que puede producir múltiples manifestaciones en el sistema nervioso central, desde ictus hasta trastornos psiquiátricos de tipo ansioso, y todos relacionados con la hipoperfusión cerebral secundaria a la hiperviscosidad. Presentamos dos pacientes que presentaron un episodio de amnesia global transitoria y que tenían una policitemia previa; además, en uno de los casos se encontró un hemangioblastoma cerebeloso. Hay numerosos casos en la literatura de lesiones intracraneales diagnosticadas a raíz de un episodio de AGT; sin embargo, no se ha descrito la relación entre la policitemia y la AGT. En la amnesia global transitoria se ha llegado a constatar una hipoperfusión de las regiones temporales y esto puede ser un mecanismo desencadenante; planteamos al posibilidad de que la policitemia sea un trastorno protrombótico que predisponga a padecer la amnesia global transitoria

Transitory global amnesia (TGA) is an upheaval where the patient has anterograde memory lost of abrupt beginning and an inferior duration to 24 h, that has been related to ischaemic, epileptogenic and migranous ethiology. On the other hand polycythaemia is classified like a prothrombotic disorder that can produce manifold manifestations in the central nervous system, from strokes to psychiatric disturbances of anxious type, and all related to the secondary cerebral hipoperfusión due to hyperviscosity. Two patients, who had a prevous diagnostic of polycythaemia suffered an episode of TGA, in addition in one of the two cases a cerebellar hemangioblastoma was found. There are numerous cases reported of brain tumors and other CNS findings diagnosed as a result of an episode of TGA, nevertheless on has not described to the relation between polycythaemia and the TGA. In the TGA a hipoperfusion of the temporal brain hemisphere has been documented and this can be a leading mechanism, so we propose that polycythaemia could ready to suffer a TGA

La amnesia global transitoria recurrente, una manifestación de la enfermedad isquémica cerebrovascular / Recurrent transient global amnesia, a manifestation of ischemic cerebrovascular disease

Fundamento y objetivo: La amnesia global transitoria (AGT) es un trastorno autolimitado de memoria anterógrada relacionado clásicamente con ataques isquémicos transitorios (AIT), migraña y epilepsia. Este estudio intenta describir las características clínicas, el perfil de factores de riesgo vascular y la evolución de la AGT comparándola con un grupo de AIT y definir variables asociadas a la recurrencia. Pacientes y método: De un grupo de 139 AGT se realizó un seguimiento medio (desviación estándar) de 71,9 (39) meses a 124 pacientes a quienes comparamos con otros 124 pacientes con AIT. Las AGT se subdividen en 2 grupos: AGT únicas (98 casos) y AGT recurrentes (26 casos). Se compararon las AGT recurrentes con las únicas y con los AIT. Resultados: La edad media de los pacientes con AGT era 63 (7,96) años y un 58% eran mujeres. Un 30% tenía antecedentes de migraña y el 30% de ansiedad. El riesgo de recurrencia anual fue del 4,4%. Las AGT recurrentes tenían más alteraciones electroencefalográficas inespecíficas. El grupo AIT tenía más factores de riesgo vascular y presentaron más episodios isquémicos posteriormente. Las AGT recurrentes y los AIT tenían los mismos factores de riesgo vascular. Las AGT recurrentes tenían más antecedentes de ictus y tendencia a presentar más episodios isquémicos que las AGT únicas. Conclusiones: En la AGT no hay un sustrato de enfermedad vascular que haga pensar en una causa isquémica por arteriosclerosis o cardioembolismo. Las AGT recurrentes son un subgrupo con mayor riesgo vascular y tendencia a tener más ictus, por lo que deberían estudiarse desde el punto de vista vascular

Background and objective: Transient Global Amnesia (TGA) is a self-limited anterograde memory loss related classically to transient ischemic attacks (TIA), migraine and epilepsy. This study intended to describe clinical characteristics, the vascular risk factors and the evolution of TGA and to define clinical factors associated with recurrence. Patients and method: Of 139 patients with TGA, 124 were followed up for a mean time of 71.9 (39) months; these patients were compared with other 124 patients with TIA. The TGA group was subdivided in 2 subgroups: Unique-TGA (98 cases): 1 episode, and recurrent-TGA (26 cases): 2 or more episodes. Recurrent-TGA were also compared with unique-TGA and the TIA groups. Results: The mean age of patients of the TGA group was 63 (7.96) and 58% were women. 30% had a history of migraine and 30% had anxiety. The risk of annual recurrence was 4.4%. Recurrent-TGA patients had more electroencephalographic registers showing non-epileptogenic abnormalities. The TIA group had more vascular risk factors and displayed more ischemic events during the follow-up. Recurrent-TGA patients had the same vascular risk factors as TIA patients and they also had a significantly more frequent history of stroke and trend to suffer new ischemic events than patients in the unique-TGA group. Conclusions: There is no vascular pathology substrate in TGA patients, suggesting an ischemic ethiology due to arteriosclerosis or cardioembolism. Patients with recurrent TGA constitute a subgroup with more vascular risk factors and an increased risk to suffer new strokes. For that reason we propose that these patients be studied as ischemic patients

Amnesia global transitoria y factores de riesgo vascular / Transient global amnesia and vascular risk factors

Introducción. La amnesia global transitoria (AGT) es un síndrome clínico determinado por un episodio de duración inferior a 24 horas consistente en desorientación temporospacial, amnesia retrógrada y anterógrada, con total recuperación posterior. Objetivos. Determinar si la presencia o ausencia de factores de riesgo vascular (FRV) en pacientes con AGT se asocia con datos clínicos y/o exploratorios diferentes. Pacientes y métodos. Estudio retrospectivo de dos grupos de 13 y 12 pacientes con AGT, que presentaban o no FRV, respectivamente. Se determinaron las variables: FRV, edad, antecedentes de migraña, factores desencadenantes, duración y repetición de los episodios, síntomas neurológicos asociados y hallazgos obtenidos mediante neuroimagen, eco-Doppler de troncos supraórticos y Doppler transcraneal. Los datos obtenidos fueron sometidos a estudio estadístico mediante análisis univariante con el test de probabilidad exacta de Fisher. Resultados. Los estudios estadísticos no mostraron diferencias significativas de las variables obtenidas entre los grupos de pacientes. Conclusiones. La AGT se ha relacionado preferentemente con la migraña, epilepsia y con la patología vascular cerebral, aunque su etiología no ha sido totalmente determinada. En el presente estudio se comparan los datos clínicos entre dos grupos de pacientes con y sin FRV que han sufrido AGT. La ausencia de diferencias significativas entre ambos inclina a desestimar la etiología vascular como único origen de este síndrome. Se ha propuesto recientemente como mecanismo fisiopatológico la depresión propagada de Leao. Según esta teoría, la patología vascular podría actuar como desencadenante, pero no probablemente como factor etiológico. Los hallazgos del presente estudio podrían apoyar esta tesis (AU)

Introduction. Transient global amnesia (TGA) is a clinical syndrome determined by an episode of less than 24 hours consisting of temporo-spatial disorientation with retrograde and anterograde amnesia followed by complete recovery. Objectives. To determine whether the presence or absence of vascular risk factors (VRF) in patients with TGA is associated with different clinical data and/or examination findings. Patients and methods. A retrospective study was made of two groups of 13 and 12 patients with TGA, who presented with and without VRF, respectively. The following variables were determined: VRF, age, a previous history of migraine, triggering factors, duration and repetition of the episodes, associated neurological symptoms and findings obtained by neuroimaging, eco-Doppler of the supra-aortic trunks and transcranial Doppler. The data were subjected to statistical analysis by univariate analysis with Fischer’s exact probability test. Results. The statistical studies showed no significant differences between the variables obtained in the two groups of patients. Conclusions. Transient global amnesia has been particularly related to migraine, epilepsy and cerebral vascular pathology, although its aetiology has not been fully determined. In this study we compare clinical data between the two groups of patients with and without VRF who have had TGA. The lack of significant differences between them tends to rule out a vascular aetiology as the sole cause of this syndrome. Recently Leao’s propagated depression has been suggested as the physiopathological mechanism involved. According to this theory, the vascular pathology might act as the trigger but probably not as the aetiological factor. The findings of our study may support this thesis (AU)