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
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.in: Vinken P.J. Bruyn G.W. Klawans H.L. Handb. Clin. Neurol. Elsevier, Amsterdam1985: 205-218
- Syndromes of transient amnesia: towards a classification. A study of 153 cases.J. Neurol. Neurosurg. Psychiatry. 1990; 53: 834-843https://doi.org/10.1136/jnnp.53.10.834
- Transient global amnesia: functional anatomy and clinical implications.Lancet Neurol. 2010; 9: 205-214https://doi.org/10.1016/S1474-4422(09)70344-8
- What does transient global amnesia really mean? Review of the literature and thorough study of 142 cases.Brain. 2006; 129: 1640-1658https://doi.org/10.1093/brain/awl105
- Detection of delayed focal MR changes in the lateral hippocampus in transient global amnesia.Neurology. 2004; 62: 2165-2170https://doi.org/10.1212/01.WNL.0000130504.88404.C9
- Selective affection of hippocampal CA-1 neurons in patients with transient global amnesia without long-term sequelae.Brain. 2006; 129: 2874-2884https://doi.org/10.1093/brain/awl248
- A multicenter study of transient global amnesia for the better detection of magnetic resonance imaging abnormalities.Eur. J. Neurol. 2020; https://doi.org/10.1111/ene.14408
- Hippocampal lesion patterns in acute posterior cerebral artery stroke: clinical and MRI findings.Stroke. 2009; 40: 2042-2045https://doi.org/10.1161/STROKEAHA.108.536144
- Ischemic amnesia: causes and outcome.Stroke. 2017; 48: 2270-2273https://doi.org/10.1161/STROKEAHA.117.017420
- Diffusion-weighted imaging for the differential diagnosis of disorders affecting the Hippocampus.Cerebrovasc. Dis. 2012; 33 (104-115–508)https://doi.org/10.1159/000332036
- Selective neuronal vulnerability of human hippocampal CA1 neurons: lesion evolution, temporal course, and pattern of hippocampal damage in diffusion-weighted MR imaging.J. Cereb. Blood Flow Metab. 2015; 35: 1836-1845https://doi.org/10.1038/jcbfm.2015.137
- Diffusion-weighted MRI in transient global amnesia and its diagnostic implications.Neurology. 2020; 95: e206-e212https://doi.org/10.1212/WNL.0000000000009783
- Transient Global Amnesia.CreateSpace Independent Publishing Platform, 2012
- Transient global amnesia and migraine.Neurology. 1981; 31: 1167-1170
- An acute tiny left putamenal lesion presenting with transient global amnesia.Neurologist. 2012; 18: 80-82https://doi.org/10.1097/NRL.0b013e318247b98a
- The transient global amnesia-migraine connection.Arch. Neurol. 1984; 41: 75-79https://doi.org/10.1001/archneur.1984.04050130081029
- Unilateral or bilateral punctate hippocampal hyperintensities on DW-MRI: seizures, amnesia, or both?.Neurol. Sci. 2018; 39: 1647-1649https://doi.org/10.1007/s10072-018-3461-8
- Transient global amnesia and migraine in twin sisters.J. Neurol. Neurosurg. Psychiatry. 1987; 50: 816-817https://doi.org/10.1136/jnnp.50.6.816
- The transient global amnesia - migraine connection case report.Funct. Neurol. 1988; 3: 353-360https://doi.org/10.1017/CBO9781107415324.004
- Transient global amnesia occurring as migraine aura.J. Headache Pain. 2000; 1: 57-59https://doi.org/10.1007/s101940050012
- Transient global amnesia as a presenting aura.Headache. 2014; 54: 551-552https://doi.org/10.1111/head.12305
- Incidental hippocampal hyperintensity on diffusion-weighted MRI: individual susceptibility to transient global amnesia.Neurologist. 2017; 22: 103-106https://doi.org/10.1097/NRL.0000000000000123
- Hippocampal lesions of diffusion weighted magnetic resonance image in patients with headache without symptoms of transient global amnesia.Dement Neurocogn Disord. 2017; 16: 87-90
- Anterior portion of the cingulate gyrus: a novel location for transient global amnesia?.Dement. Neuropsychol. 2014; 8: 90-92https://doi.org/10.1590/s1980-57642014dn81000015
- Transient global amnesia as the sole presentation of an acute stroke in the left cingulate gyrus.Case Rep. Neurol. Med. 2019; : 4810629https://doi.org/10.1155/2019/4810629
- A case of transient global amnesia with small left putamen infarction.J. Stroke Cerebrovasc. Dis. 2017; 26: e27-e28https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.10.028
- Frequency of silent brain infarction in transient global amnesia.J. Neurol. 2021; https://doi.org/10.1007/s00415-021-10705-4
- Transient epileptic amnesia: a description of the clinical and neuropsychological features in 10 cases and a review of the literature.J. Neurol. Neurosurg. Psychiatry. 1998; 64: 435-443https://doi.org/10.1136/jnnp.64.4.435
- Incidence and prognosis of transient neurological attacks.JAMA. 2007; 298: 2877-2885https://doi.org/10.1001/jama.298.24.2877
- Rate and prognosis of brain ischemia in patients with lower-risk transient or persistent minor neurologic events.JAMA Neurol. 2019; 76: 1439-1445https://doi.org/10.1001/jamaneurol.2019.3063
- Sex differences in presentation and outcome after an acute transient or minor neurologic event.JAMA Neurol. 2019; 76: 962-968https://doi.org/10.1001/jamaneurol.2019.1305
- Operational classification of seizure types by the international league against epilepsy: position paper of the ILAE commission for classification and terminology.Epilepsia. 2017; 58: 522-530https://doi.org/10.1111/epi.13670
- The International Classification of Headache Disorders, 3rd edition, Cephalalgia.38. 2018: 1-211https://doi.org/10.1177/0333102417738202
- Transient global amnesia: an electrophysiological disorder based on cortical spreading depression—transient global amnesia model.Front. Hum. Neurosci. 2020; 14: 1-8https://doi.org/10.3389/fnhum.2020.602496
Article info
Publication history
Published online: July 22, 2022
Accepted:
July 19,
2022
Received in revised form:
July 7,
2022
Received:
March 4,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
