Transient global amnesia: related factors, imaging features, and prognosis_West China Medical Journal

Authors：

HE Shunpo ^1,2 , LAI Xiaodong ³ , LIN Jianzhong ¹ , CHEN Xingyu ¹ ,  YANG Qingwei ¹ , CHEN Zhongjie ¹ , CHEN Liangyi ¹ , YANG Huili ¹ , PENG Zhongwei ¹

1. Department of Neurology, Zhongshan Hospital Xiamen University, Xiamen, Fujian 361004, P. R. China;
2. College of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian 350108, P. R. China;
3. Fuzhou Medical College, Nanchang University, Fuzhou, Jiangxi 344100, P. R. China;

Corresponding?author：

YANG Qingwei, Email: yiheng66@126.com

Keywords：

Transient global amnesia; Risk factors; Imaging features; Prognosis

DOI：

10.7507/1002-0179.202005003

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Objective To explore the related factors, responsible lesions, and prognosis of transient global amnesia (TGA).Methods We retrospectively collected TGA patients admitted to Zhongshan Hospital Xiamen University between October 1st 2011 and October 31st 2018 and age- and sex-matched health examinees in the Department of Physical Examination in the same period as a control group. We recorded the relevant clinical information of the two groups, such as sex, age, hypertension, diabetes, hyperlipidemia, atrial fibrillation, stroke, migraine, TGA and epilepsy, and the imaging data of the TGA patients. The occurrences of cerebral infarction, cerebral hemorrhage, recurrence of TGA, and myocardial infarction of the two groups were followed up.Results A total of 73 TGA patients and 73 age- and sex-matched controls were included. The difference in the history of migraine was statistically significant (χ²=4.000, P=0.038), while there was no significant difference in the history of hypertension, diabetes or other medical history between the two groups (P>0.05). It was found that the responsible focus of TGA was in the hippocampal CA1 region, while the fornix column and the hippocampal CA1 region existed in the same functional loop. The mean follow-up time was (36.0±22.6) months. Sixty-nine TGA patients and 67 healthy controls were followed up. During the follow-up, there was no significant difference in the incidence of cerebral infarction, cerebral hemorrhage, myocardial infarction, or TGA attacks between the two groups (P>0.05). There was no statistically significant difference (P>0.05) in the clinical or follow-up data between the TGA patients with lesion on DWI (n=9) and the ones without lesion on DWI (n=58).Conclusions Migraine may be a risk factor for TGA. The responsible brain area of TGA may involve a memory loop, including hippocampal CA1 region, fornix column and so on. After the attack of TGA, the long-term prognosis is well.

Citation： HE Shunpo, LAI Xiaodong, LIN Jianzhong, CHEN Xingyu, YANG Qingwei, CHEN Zhongjie, CHEN Liangyi, YANG Huili, PENG Zhongwei. Transient global amnesia: related factors, imaging features, and prognosis. West China Medical Journal, 2020, 35(12): 1478-1483. doi: 10.7507/1002-0179.202005003 Copy

1.	Bender MB. Single episode of confusion with amnesia. Bull N Y Acad Med, 1960, 36(3): 197-207.
2.	Arena JE, Rabinstein AA. Transient global amnesia. Mayo Clin Proc, 2015, 90(2): 264-272.
3.	Gupta M, Kantor MA, Tung CE, et al. Transient global amnesia associated with a unilateral infarction of the fornix: case report and review of the literature. Front Neurol, 2015, 5: 291.
4.	Caplan L, Chedru F, Lhermitte F, et al. Transient global amnesia and migraine. Neurology, 1981, 31(9): 1167-1170.
5.	Hodges JR, Warlow CP. Syndromes of transient amnesia: towards a classification. A study of 153 cases. J Neurol Neurosurg Psychiatry, 1990, 53(10): 834-843.
6.	Quinette P, Guillery-Girard B, Dayan J, et al. What does transient global amnesia really mean? Review of the literature and thorough study of 142 cases. Brain, 2006, 129(Pt 7): 1640-1658.
7.	Zeman AZ, Hodges JR. Transient global amnesia. Br J Hosp Med, 1997, 58(6): 257-260.
8.	Pantoni L, Bertini E, Lamassa M, et al. Clinical features, risk factors, and prognosis in transient global amnesia: a follow-up study. Eur J Neurol, 2005, 12(5): 350-356.
9.	Michel P, Beaud V, Eskandari A, et al. Ischemic amnesia: causes and outcome. Stroke, 2017, 48(8): 2270-2273.
10.	Zorzon M, Antonutti L, Giovanni M, et al. Transient global amnesia and transient ischemic attack. Stroke, 1995, 26(9): 1536-1542.
11.	Pi?ol-Ripoll G, de la Puerta González-Miró I, Martínez L, et al. A study of the risk factors in transient global amnesia and its differentiation from a transient ischemic attack. Rev Neurol, 2005, 41(9): 513-516.
12.	Jang JW, Park SY, Hong JH, et al. Different risk factor profiles between transient global amnesia and transient ischemic attack: a large case-control study. Eur Neurol, 2014, 71(1/2): 19-24.
13.	Kim J, Kwon Y, Yang Y, et al. Clinical experience of modified diffusion-weighted imaging protocol for lesion detection in transient global amnesia: an 8-year large-scale clinical study. J Neuroimaging, 2014, 24(4): 331-337.
14.	Winbeck K, Etgen T, von Einsiedel HG, et al. DWI in transient global amnesia and TIA: proposal for an ischaemic origin of TGA. J Neurol Neurosurg Psychiatry, 2005, 76(3): 438-441.
15.	Bartsch T, Alfke K, Stingele R, et al. Selective affection of hippocampal CA-1 neurons in patients with transient global amnesia without long-term sequelae. Brain, 2006, 129(Pt 11): 2874-2884.
16.	Yang YK, Kim JH. Ischemic evidence of transient global amnesia: location of the lesion in the hippocampus. J Clin Neurol, 2008, 4(2): 59-66.
17.	Hanert A, Pedersen A, Bartsch T. Transient hippocampal CA1 lesions in humans impair pattern separation performance. Hippocampus, 2019, 29(8): 736-747.
18.	Imperatori C, Farina B, Todini F, et al. Abnormal EEG power spectra in acute transient global amnesia: a quantitative EEG study. Clin EEG Neurosci, 2019, 50(3): 188-195.
19.	Jain TP, Patel R, Gawarikar Y. Transient global amnesia: diffusion MRI findings. Indian J Radiol Imaging, 2018, 28(1): 6-9.
20.	Jeong M, Jin J, Kim JH, et al. Incidental hippocampal hyperintensity on diffusion-weighted MRI: individual susceptibility to transient global amnesia. Neurologist, 2017, 22(4): 103-106.
21.	Wang X, Zhang R, Wei W, et al. Long-term sequelae of hippocampal lesions in patients with transient global amnesia: a multiparametric MRI study. J Magn Reson Imaging, 2018, 47(5): 1350-1358.
22.	Moon YJ, Han SH. The structural connectivity of the recurrent transient global amnesia. Acta Neurol Scand, 2016, 134(2): 160-164.
23.	Mangla A, Navi BB, Layton K, et al. Transient global amnesia and the risk of ischemic stroke. Stroke, 2014, 45(2): 389-393.
24.	Webb AS, Rothwell PM. Transient global amnesia associated with bilateral restricted diffusion in the lateral hippocampus. J Neurol Neurosurg Psychiatry, 2013, 84(5): 522-522.
25.	Squire LR, Stark CE, Clark RE. The medial temporal lobe. Annu Rev Neurosci, 2004, 27: 279-306.
26.	Rolls ET, Kesner RP. A computational theory of hippocampal function, and empirical tests of the theory. Prog Neurobiol, 2006, 79(1): 1-48.
27.	Duncan K, Tompary A, Davachi L. Associative encoding and retrieval are predicted by functional connectivity in distinct hippocampal area CA1 pathways. J Neurosci, 2014, 34(34): 11188-11198.
28.	Yi M, Sherzai AZ, Ani C, et al. Strong association between migraine and transient global amnesia: a national inpatient sample analysis. J Neuropsychiatry Clin Neurosci, 2019, 31(1): 43-48.
29.	Schwedt TJ, Dodick DW. Advanced neuroimaging of migraine. Lancet Neurol, 2009, 8(6): 560-568.
30.	Pomper JK, Haack S, Petzold GC, et al. Repetitive spreading depression-like events result in cell damage in juvenile hippocampal slice cultures maintained in normoxia. J Neurophysiol, 2006, 95(1): 355-368.
31.	Bartsch T, Deuschl G. Transient global amnesia: functional anatomy and clinical implications. Lancet Neurol, 2010, 9(2): 205-214.
32.	Berli R, Hutter A, Waespe W, et al. Transient global amnesia - not so rare after all. Swiss Med Wkly, 2009, 139(19/20): 288-292.
33.	韓珂, 趙雅琴, 張豐基, 等. 靜脈回流障礙與短暫性全面遺忘癥的相關性. 中國卒中雜志, 2016, 11(7): 547-555.
34.	Han K, Hu HH, Chao AC, et al. Transient global amnesia linked to impairment of brain venous drainage: an ultrasound investigation. Front Neurol, 2019, 10: 67.

1. Bender MB. Single episode of confusion with amnesia. Bull N Y Acad Med, 1960, 36(3): 197-207.
2. Arena JE, Rabinstein AA. Transient global amnesia. Mayo Clin Proc, 2015, 90(2): 264-272.
3. Gupta M, Kantor MA, Tung CE, et al. Transient global amnesia associated with a unilateral infarction of the fornix: case report and review of the literature. Front Neurol, 2015, 5: 291.
4. Caplan L, Chedru F, Lhermitte F, et al. Transient global amnesia and migraine. Neurology, 1981, 31(9): 1167-1170.
5. Hodges JR, Warlow CP. Syndromes of transient amnesia: towards a classification. A study of 153 cases. J Neurol Neurosurg Psychiatry, 1990, 53(10): 834-843.
6. Quinette P, Guillery-Girard B, Dayan J, et al. What does transient global amnesia really mean? Review of the literature and thorough study of 142 cases. Brain, 2006, 129(Pt 7): 1640-1658.
7. Zeman AZ, Hodges JR. Transient global amnesia. Br J Hosp Med, 1997, 58(6): 257-260.
8. Pantoni L, Bertini E, Lamassa M, et al. Clinical features, risk factors, and prognosis in transient global amnesia: a follow-up study. Eur J Neurol, 2005, 12(5): 350-356.
9. Michel P, Beaud V, Eskandari A, et al. Ischemic amnesia: causes and outcome. Stroke, 2017, 48(8): 2270-2273.
10. Zorzon M, Antonutti L, Giovanni M, et al. Transient global amnesia and transient ischemic attack. Stroke, 1995, 26(9): 1536-1542.
11. Pi?ol-Ripoll G, de la Puerta González-Miró I, Martínez L, et al. A study of the risk factors in transient global amnesia and its differentiation from a transient ischemic attack. Rev Neurol, 2005, 41(9): 513-516.
12. Jang JW, Park SY, Hong JH, et al. Different risk factor profiles between transient global amnesia and transient ischemic attack: a large case-control study. Eur Neurol, 2014, 71(1/2): 19-24.
13. Kim J, Kwon Y, Yang Y, et al. Clinical experience of modified diffusion-weighted imaging protocol for lesion detection in transient global amnesia: an 8-year large-scale clinical study. J Neuroimaging, 2014, 24(4): 331-337.
14. Winbeck K, Etgen T, von Einsiedel HG, et al. DWI in transient global amnesia and TIA: proposal for an ischaemic origin of TGA. J Neurol Neurosurg Psychiatry, 2005, 76(3): 438-441.
15. Bartsch T, Alfke K, Stingele R, et al. Selective affection of hippocampal CA-1 neurons in patients with transient global amnesia without long-term sequelae. Brain, 2006, 129(Pt 11): 2874-2884.
16. Yang YK, Kim JH. Ischemic evidence of transient global amnesia: location of the lesion in the hippocampus. J Clin Neurol, 2008, 4(2): 59-66.
17. Hanert A, Pedersen A, Bartsch T. Transient hippocampal CA1 lesions in humans impair pattern separation performance. Hippocampus, 2019, 29(8): 736-747.
18. Imperatori C, Farina B, Todini F, et al. Abnormal EEG power spectra in acute transient global amnesia: a quantitative EEG study. Clin EEG Neurosci, 2019, 50(3): 188-195.
19. Jain TP, Patel R, Gawarikar Y. Transient global amnesia: diffusion MRI findings. Indian J Radiol Imaging, 2018, 28(1): 6-9.
20. Jeong M, Jin J, Kim JH, et al. Incidental hippocampal hyperintensity on diffusion-weighted MRI: individual susceptibility to transient global amnesia. Neurologist, 2017, 22(4): 103-106.
21. Wang X, Zhang R, Wei W, et al. Long-term sequelae of hippocampal lesions in patients with transient global amnesia: a multiparametric MRI study. J Magn Reson Imaging, 2018, 47(5): 1350-1358.
22. Moon YJ, Han SH. The structural connectivity of the recurrent transient global amnesia. Acta Neurol Scand, 2016, 134(2): 160-164.
23. Mangla A, Navi BB, Layton K, et al. Transient global amnesia and the risk of ischemic stroke. Stroke, 2014, 45(2): 389-393.
24. Webb AS, Rothwell PM. Transient global amnesia associated with bilateral restricted diffusion in the lateral hippocampus. J Neurol Neurosurg Psychiatry, 2013, 84(5): 522-522.
25. Squire LR, Stark CE, Clark RE. The medial temporal lobe. Annu Rev Neurosci, 2004, 27: 279-306.
26. Rolls ET, Kesner RP. A computational theory of hippocampal function, and empirical tests of the theory. Prog Neurobiol, 2006, 79(1): 1-48.
27. Duncan K, Tompary A, Davachi L. Associative encoding and retrieval are predicted by functional connectivity in distinct hippocampal area CA1 pathways. J Neurosci, 2014, 34(34): 11188-11198.
28. Yi M, Sherzai AZ, Ani C, et al. Strong association between migraine and transient global amnesia: a national inpatient sample analysis. J Neuropsychiatry Clin Neurosci, 2019, 31(1): 43-48.
29. Schwedt TJ, Dodick DW. Advanced neuroimaging of migraine. Lancet Neurol, 2009, 8(6): 560-568.
30. Pomper JK, Haack S, Petzold GC, et al. Repetitive spreading depression-like events result in cell damage in juvenile hippocampal slice cultures maintained in normoxia. J Neurophysiol, 2006, 95(1): 355-368.
31. Bartsch T, Deuschl G. Transient global amnesia: functional anatomy and clinical implications. Lancet Neurol, 2010, 9(2): 205-214.
32. Berli R, Hutter A, Waespe W, et al. Transient global amnesia - not so rare after all. Swiss Med Wkly, 2009, 139(19/20): 288-292.
33. 韓珂, 趙雅琴, 張豐基, 等. 靜脈回流障礙與短暫性全面遺忘癥的相關性. 中國卒中雜志, 2016, 11(7): 547-555.
34. Han K, Hu HH, Chao AC, et al. Transient global amnesia linked to impairment of brain venous drainage: an ultrasound investigation. Front Neurol, 2019, 10: 67.

West China Medical Journal

Transient global amnesia: related factors, imaging features, and prognosis

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