Highlights
- •Precipitating events are present in nearly 70% of patients with TGA.
- •TGA patients show a sex-related difference in susceptibility to triggering events.
- •Sex-specific differences in stress vulnerability may contribute to TGA pathogenesis.
Abstract
Introduction
Physically or emotionally charged events have consistently been reported as precipitating
an episode of transient global amnesia (TGA). In conjunction with evidence of hippocampal
involvement from neuroimaging, this has promoted the hypothesis that TGA is a stress-related
disorder.
Methods
In this retrospective observational study, medical records of 389 patients with TGA
were analysed regarding documented precipitating events, which were classified according
to previously suggested criteria. Moreover, comorbidities and results of magnetic
resonance imaging were collected.
Findings
In our cohort of TGA patients, 231 were female (59.4%). A precipitating factor was
identified in 266 patients (68.4%). Of these, 136 patients (51.1%) reported physical
triggers, the most common being physical exertion (64.0%). Another 122 patients (45.9%)
presented with an emotional trigger, most frequently classified as an interpersonal
conflict (42.7%). In 8 cases (2.1%), TGA was preceded by a medical procedure. Emotional
triggers were more often experienced by women (37.2% vs 22.8%, p = 0.003), while physical stressors were more often present in men (30.7% vs 41.1%,
p = 0.035). Women had a significantly higher number of hippocampal MRI lesions than
men (mean 1.13 vs 0.92; p = 0.042).
Conclusion
Our data suggest a female predominance in TGA occurrence and a sex-related difference
in susceptibility to certain triggering events in TGA patients. In light of recent
research on sex-specific differences in vulnerability to stress, these findings support
the hypothesis that this might be a significant contributing factor in the pathogenesis
of TGA.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the Neurological SciencesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Transient global amnesia.Trans. Am. Neurol. Assoc. 1958; 83: 143-146
- What does transient global amnesia really mean? Review of the literature and thorough study of 142 cases.Brain. 2006; 129: 1640-1658
- Transient global amnesia. Precipitating activities and other observations.Arch. Neurol. 1982; 39: 605-608
- Transient global amnesia: functional anatomy and clinical implications.Lancet Neurol. 2010; 9: 205-214
- The aetiology of transient global amnesia. A case-control study of 114 cases with prospective follow-up.Brain J. Neurol. 1990; 113: 639-657
- Psychological stress and coping in aging.Am. Psychol. 1983; 38: 245-254
- More than a feeling: a unified view of stress measurement for population science.Front. Neuroendocrinol. 2018; 49: 146-169
- Trigger factors in takotsubo syndrome - a systematic review of case reports.Eur. J. Intern. Med. 2019; 63: 62-68
- Shedding light on the clinical recognition process of transient global amnesia.Eur. J. Neurol. 2020; 27: 1821-1824
- Transient global amnesia, Acta Neurol Scand Suppl 40.SUPPL. 1964; 9: 1-83
- Transient global amnesia following neural and cardiac angiography may be related to ischemia.Biomed. Res. Int. 2016; 2016: 2821765
- Transient global amnesia. A report of eleven cases, including five of amnesia at the seaside.Ir. J. Med. Sci. 1970; 3: 331-335
- Stress revisited: a critical evaluation of the stress concept.Neurosci. Biobehav. Rev. 2011; 35: 1291-1301
- Stress, mental disorders and coronary heart disease.Nervenarzt. 2012; 83: 1448-1457
- Interaction between the heart and the brain in transient global amnesia.J. Neurol. 2019; 266: 3048-3057
- Incidence of transient global amnesia in Merano, province of Bolzano, Italy.Acta Neurol. Belg. 2014; 114: 293-296
- Sex differences in Takotsubo syndrome: a narrative review.J. Women’s Health (Larchmt). 2020; 29: 1122-1130
- Psychological distress and subsequent cardiovascular events in individuals with coronary artery disease.J. Am. Heart Assoc. 2019; 8e011866
- Sex differences in stress-related disorders: major depressive disorder, bipolar disorder, and posttraumatic stress disorder.Handb. Clin. Neurol. 2020; 175: 335-358
- Transient global amnesia: memory and metamemory.Aging (Milano). 1995; 7: 423-429
- Clinical features, risk factors, and prognosis in transient global amnesia: a follow-up study.Eur. J. Neurol. 2005; 12: 350-356
- Emotional arousal and phobia in transient global amnesia.Arch. Neurol. 1997; 54: 866-873
- Stress-related factors in the emergence of transient global amnesia with hippocampal lesions.Front. Behav. Neurosci. 2014; 8: 287
- Enhanced cortisol secretion in acute transient global amnesia.Psychoneuroendocrinology. 2019; 99: 72-79
- Serum cortisol levels in patients with a transient global amnesia.Rev. Neurol. (Paris). 2020; 176: 285-288
- Stronger pharmacological cortisol suppression and anticipatory cortisol stress response in transient global amnesia.Front. Behav. Neurosci. 2015; 9: 63
- The distribution of the transient global amnesia in the province of Ferrara, Italy, a clue to the pathogenesis?.Neurol. Sci. 2020; 42: 1821-1826
- City living and urban upbringing affect neural social stress processing in humans.Nature. 2011; 474: 498-501
Article info
Publication history
Published online: April 16, 2021
Accepted:
April 15,
2021
Received in revised form:
April 6,
2021
Received:
February 10,
2021
Identification
Copyright
© 2021 Published by Elsevier B.V.
