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Transient global amnesia with unexpected clinical and radiological findings: A case series and systematic review

  • Author Footnotes
    1 These authors contributed equally to the manuscript.
    Silvio Piffer
    Correspondence
    Corresponding author at: Stroke Centre and Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, CH-1011, Switzerland.
    Footnotes
    1 These authors contributed equally to the manuscript.
    Affiliations
    Stroke Centre and Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland

    Neurology Unit, Department of Emergency, Santa Chiara Hospital, Trento, Italy
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  • Author Footnotes
    1 These authors contributed equally to the manuscript.
    Stefania Nannoni
    Footnotes
    1 These authors contributed equally to the manuscript.
    Affiliations
    Stroke Centre and Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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  • Francesco Maulucci
    Affiliations
    Stroke Centre EOC, Neurology Department, Neurocentre of Southern Switzerland (NSI), Ospedale Civico, Lugano, Switzerland
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  • Valérie Beaud
    Affiliations
    Neuropsychology and Neurorehabilitation Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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  • Olivier Rouaud
    Affiliations
    Leenaards Memory Centre, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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  • Alex Förster
    Affiliations
    Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
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  • Carlo W. Cereda
    Affiliations
    Stroke Centre EOC, Neurology Department, Neurocentre of Southern Switzerland (NSI), Ospedale Civico, Lugano, Switzerland
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  • Philippe Maeder
    Affiliations
    Department of Radiology, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland
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  • Patrik Michel
    Affiliations
    Stroke Centre and Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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  • Author Footnotes
    1 These authors contributed equally to the manuscript.

      Highlights

      • TGA may occasionally be accompanied by clinical features outside the strict original definition.
      • In addition to the characteristic HPDL, extra-hippocampal punctate vanishing lesions may be seen in TGA.
      • We propose a the term “TGA-HPDL spectrum”, allowing classification also of atypical clinical and radiological cases.

      Abstract

      Background

      Transient global amnesia (TGA) represents a benign neurological syndrome of unknown pathophysiology, often accompanied by vanishing hippocampal punctate diffusion-weighted imaging lesions (HPDL). The literature suggests that TGA may present with unusual features. This study analyses atypical clinical and radiological manifestations of patients with TGA and/or HPDL.

      Methods

      We retrospectively reviewed patients with atypical clinical or radiological presentations of TGA and/or HPDL in three neurology centers. We also performed a systematic review of literature using predefined search terms. Results were classified as: A) Atypical clinical manifestations of TGA (such as amnesia with additional manifestations, or only non-amnesic manifestations); B) Atypical radiological manifestations of clinically typical TGA.

      Results

      We identified 83 patients: 18 in our centres (median age 63.5 years, 39% female) and 65 in the literature. In group A, 43 patients presented atypical clinical manifestations such as TGA with added transitory cognitive or sensory-motor deficits, seizures, headaches, but also non-amnesic presentations associated with HPDL and incidental HPDL without symptoms. In group B, 40 patients with typical clinical TGA showed extra-hippocampal punctate diffusion lesions (E-HPDL) which disappeared on follow-up imaging. Using clinical and radiological manifestations, we classified these patients into different categories describing a “TGA-PDL spectrum”.

      Conclusions

      TGA may have atypical clinical manifestations despite typical neuroimaging and patients with typical TGA may show vanishing extra-hippocampal punctate diffusion lesions. TGA, related clinical manifestations, and vanishing punctate diffusion lesions should be considered part of a larger “TGA-PDL spectrum”, allowing for better diagnosis of typical and atypical cases and stimulating further studies.

      Keywords

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