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Diffusion-weighted imaging in transient global amnesia exposes the CA1 region of the hippocampus

  • Diagnostic Neuroradiology
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Abstract

Introduction

Transient global amnesia (TGA) is characterized by a sudden onset of anterograde amnesia without alteration of consciousness or personal identity. Interestingly, recent studies have reported a high frequency of small high-signal abnormalities in the hippocampus with diffusion-weighted (DW) imaging, and ischemia has been proposed as an etiology of TGA. We hypothesized that TGA lesions occur preferentially in the CA1 region of the hippocampus, known to be susceptible to ischemia.

Methods

Over a 30-month period 34 patients with TGA underwent MRI including DW imaging within 4 days of symptom onset. Patients with high-signal abnormalities in the hippocampus on the initial DW images underwent subsequent DW and T2-weighted imaging in the coronal plane to identify the precise lesion locations.

Results

Fourteen patients had small (1–3 mm) high-signal abnormalities in the hippocampus unilaterally on DW images. One of these patients had two lesions in one hippocampus and therefore in total 15 lesions were identified: four in the hippocampal head, and 11 in the body. Eleven lesions in ten patients with available coronal images were clearly demonstrated on both coronal DW and T2-weighted images and were localized to the lateral portion of the hippocampus, corresponding to the CA1 region.

Conclusion

Lesions associated with TGA were localized exclusively to the lateral portion of the hippocampus corresponding to the CA1 region. This finding supports the ischemic etiology of TGA; however, the pathophysiological mechanism involved requires further study.

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References

  1. Hodges JR, Warlow CP (1990) Syndromes of transient amnesia: towards a classification. A study of 153 cases. J Neurol Neurosurg Psychiatry 53:834–843

    PubMed  CAS  Google Scholar 

  2. Hodges JR, Warlow CP (1990) The aetiology of transient global amnesia: a case control study of 114 cases with prospective follow-up. Brain 113:639–657

    Article  PubMed  Google Scholar 

  3. Tong DC, Grossman M (2004) What causes transient global amnesia? Neurology 62:2154–2155

    PubMed  Google Scholar 

  4. Pantoni L, Lamassa M, Inzitari D (2000) Transient global amnesia: a review emphasizing pathogenic aspects. Acta Neurol Scand 102:275–283

    Article  PubMed  CAS  Google Scholar 

  5. Ay H, Furie KL, Yamada K, et al (1998) Diffusion-weighted MRI characterizes the ischemic lesion in transient global amnesia. Neurology 51:901–903

    PubMed  CAS  Google Scholar 

  6. Sedlaczek O, Hirsch JG, Grips E, et al (2004) Detection of delayed focal MR changes in the lateral hippocampus in transient global amnesia. Neurology 62:2165–2170

    PubMed  CAS  Google Scholar 

  7. Winbeck K, Etgen T, von Einsiedel HG, Röttinger M, Sander D (2005) DWI in transient global amnesia and TIA: proposal for an ischaemic origin of TGA. J Neurol Neurosurg Psychiatry 76:438–741

    Article  PubMed  CAS  Google Scholar 

  8. Cianfoni A, Tartaglione T, Gaudino S, et al (2005) Hippocampal magnetic resonance imaging abnormalities in transient global amnesia. Arch Neurol 62:1468–1469

    Article  PubMed  Google Scholar 

  9. Matsuda H, Higashi S, Tsuji S, et al (1993) High resolution Tc99m HMPAO SPECT in a patient with transient global amnesia. Clin Nucl Med 18:46–49

    Article  PubMed  CAS  Google Scholar 

  10. Stillhard G, Landis T, Schiess R, Regard M, Sialer G (1993) Bitemporal hypoperfusion in transient global amnesia: 99m-Tc-HM-PAO SPECT and neuropsychological findings during and after an attack. J Neurol Neurosurg Psychiatry 53:339–342

    Google Scholar 

  11. Warren JD, Chatterton B, Thompson PD (2000) A SPECT study of the anatomy of transient global amnesia. J Clin Neurosci 7:57–59

    Article  PubMed  CAS  Google Scholar 

  12. Jovin TG, Vitti RA, McCluskey LF (2000) Evolution of temporal lobe hypoperfusion in transient global amnesia: a serial single photon emission computed tomography study. J Neuroimaging 10:238–241

    PubMed  CAS  Google Scholar 

  13. Strupp M, Bruning R, Wu RH, Deimling M, Reiser M, Brandt T (1998) Diffusion-weighted MRI in transient global amnesia: elevated signal intensity in the left mesial temporal lobe in 7 of 10 patients. Ann Neurol 43:164–170

    Article  PubMed  CAS  Google Scholar 

  14. Matsui M, Imamura T, Sakamoto S, Ishii K, Kazui H, Mori E (2002) Transient global amnesia: increased signal intensity in the right hippocampus on diffusion-weighted magnetic resonance imaging. Neuroradiology 44:235–238

    Article  PubMed  CAS  Google Scholar 

  15. Heiman M (1937) Über Gefässstudien am aufgehellten Gehirn. I. Die Gefässe des Ammonshornes. Arch Neurol Neurochir Psychiatr 40:277–302

    Google Scholar 

  16. Caplan L (1985) Transient global amnesia. In: Vinken PJ, Bruyn GW, Klawans HL (eds) Handbook of clinical neurology. Elsevier Science, Amsterdam, pp 205–218

    Google Scholar 

  17. Duvernoy HM (1988) The human hippocampus: an atlas of applied anatomy. JF Bergmann Verlag, Munich, pp 1–60

    Google Scholar 

  18. Tien RD, Felsberg GJ, Crain B (1992) Normal anatomy of the hippocampus and adjacent temporal lobe: high-resolution fast spin-echo MR images in volunteers correlated with cadaveric histologic sections. AJR Am J Roentgenol 159:1309–1313

    PubMed  CAS  Google Scholar 

  19. Steinmetz EF, Vroom FQ (1972) Transient global amnesia. Neurology 22:1193–1200

    PubMed  CAS  Google Scholar 

  20. Fogelholm R, Kivalo E, Bergstrom L (1975) The transient global amnesia syndrome. An analysis of 35 cases. Eur Neurol 13:72–84

    PubMed  CAS  Google Scholar 

  21. Shuping JR, Rollinson RD, Toole JF (1980) Transient global amnesia. Ann Neurol 7:281–285

    Article  PubMed  CAS  Google Scholar 

  22. Miller JW, Petersen RC, Metter EJ, Millikan CH, Yanagihara T (1987) Transient global amnesia: clinical characteristics and prognosis. Neurology 37:733–737

    PubMed  CAS  Google Scholar 

  23. Zorzon M, Antonutti L, Masè G, Biasutti E, Vitrani B, Cazzato G (1995) Transient global amnesia and transient ischemic attack: natural history, vascular risk factors, and associated conditions. Stroke 26:1536–1542

    PubMed  CAS  Google Scholar 

  24. Lewis SL (1998) Aetiology of transient global amnesia. Lancet 352:397–399

    Article  PubMed  CAS  Google Scholar 

  25. Sander D, Winbeck K, Etgen T, Knapp R, Klingelhofer J, Conrad B (2000) Disturbance of venous flow patterns in patients with transient global amnesia. Lancet 356:1982–1984

    Article  PubMed  CAS  Google Scholar 

  26. Schreiber SJ, Doepp F, Klingebiel R, Valdueza JM (2005) Internal jugular vein valve incompetence and intracranial venous anatomy in transient global amnesia. J Neurol Neurosurg Psychiatry 76:509–513

    Article  PubMed  CAS  Google Scholar 

  27. Guidotti M, Anzalone N, Morabito A, Landi G (1989) A case-control study of transient global amnesia. J Neurol Neurosurg Psychiatry 52:320–323

    Article  PubMed  CAS  Google Scholar 

  28. Santos S, Lopez del Val J, Tejero C, Iniguez C, Lalana JM, Morales F (2000) Transient global amnesia: a review of 58 cases. Rev Neurol 30:1113–1117

    PubMed  CAS  Google Scholar 

  29. Marinkovic S, Milisavljevic M, Puskas L (1992) Microvascular anatomy of the hippocampal formation. Surg Neurol 37:339–349

    Article  PubMed  CAS  Google Scholar 

  30. Nakada T, Kwee IL, Fujii Y, Knight RT (2005) High-field, T2 reversed MRI of the hippocampus in transient global amnesia. Neurology 64:1170–1174

    PubMed  Google Scholar 

  31. Huber R, Aschoff AJ, Ludolph AC, Riepe MW (2002) Transient global amnesia. Evidence against vascular ischemic etiology from diffusion weighted imaging. J Neurol 249:1520–1524

    Article  PubMed  CAS  Google Scholar 

  32. Provenzale JM, Engelter ST, Petrella JR, Smith JS, MacFall JR (1995) Use of MR exponential diffusion-weighted images to eradicate T2 “shine-through” effect. AJR Am J Roentgenol 172:537–539

    Google Scholar 

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Acknowledgement

This study was supported by the New Technology Seoul R&BD Program, Republic of Korea (project number 10675).

Conflict of interest statement

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, 463-707, South Korea

    Ho Yun Lee, Jae Hyoung Kim, Young-Cheol Weon, Sung Won Youn & Sung Hyun Kim

  2. Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, 463-707, South Korea

    Jung Seok Lee & Sang Yun Kim

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  1. Ho Yun Lee
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Correspondence to Jae Hyoung Kim.

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Lee, H.Y., Kim, J.H., Weon, YC. et al. Diffusion-weighted imaging in transient global amnesia exposes the CA1 region of the hippocampus. Neuroradiology 49, 481–487 (2007). https://doi.org/10.1007/s00234-007-0213-5

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  • DOI: https://doi.org/10.1007/s00234-007-0213-5

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