Disturbance of venous flow patterns in patients with transient global amnesia

doi:10.1016/S0140-6736(00)03313-4

The Lancet

Volume 356, Issue 9246, 9 December 2000, Pages 1982-1984

https://doi.org/10.1016/S0140-6736(00)03313-4 Get rights and content

Summary

Transient global amnesia (TGA) is an inability to form new memories. The pathophysiology and cause of TGA have not been defined. We examined the changes of internal jugular venous flow patterns in 21 patients with TGA and 21 age-matched and sex-matched controls using duplex ultrasonography during two Valsalva manoeuvres (blocking venous return through the superior vena cava). During both manoeuvres a retrograde flow component was seen significantly more frequently in the TGA group than in the controls. Ten patients reported Valsalva-like activities preceding TGA. In these patients a retrograde flow component took place more frequently than in those who did not report preceding Valsalva-like activities. Our results lend support to the hypothesis that TGA may be attributable to venous congestion, and consequent venous ischaemia to bilateral diencephalic or hippocampal structures.

References (5)

SL Lewis
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Lancet
(1998)
JR Hodges et al.
Syndromes of transient amnesia: towards a classification: a study of 153 cases
J Neurol Neurosurg Psychiatry
(1990)

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Cited by (131)

Conventional cardiovascular risk factors in Transient Global Amnesia: Systematic review and proposition of a novel hypothesis
2021, Frontiers in Neuroendocrinology
Citation Excerpt :
On the other hand, 8 articles reported a similar prevalence of DM between the two groups (Akkawi et al., 2003; Baracchini et al., 2012; Enzinger et al., 2008; Han et al., 2015; Hodges and Warlow 1990b; Jovanovic et al., 2018; Kang et al., 2015; Zorzon et al., 1995), while only one of them reported the diagnosis of DM according to the current WHO diagnostic criteria (Baracchini et al., 2012). Three articles (not providing the diagnostic criteria of DM) were probably underpowered to detect any difference (Chung et al., 2007; Lochner et al., 2014; Sander et al., 2000). Nevertheless, the absolute proportions of diabetic TGA patients were lower or equal to HC in all but one study (which reported the identification of 2/45 and 1/45 diabetic patients respectively (Han et al., 2015)).
Transient Global Amnesia (TGA) is an enigmatic amnestic syndrome. We conducted a systematic review to investigate the relationship between the conventional cardiovascular risk factors and TGA. MEDLINE, CENTRAL, EMBASE and PsycINFO were comprehensively searched and 23 controlled observational studies were retrieved. The prevalence of hypertension, diabetes mellitus, dyslipidemia and smoking was lower among patients with TGA compared to Transient Ischemic Attack. Regarding the comparison of TGA with healthy individuals, there was strong evidence suggesting a protective effect of diabetes mellitus on TGA and weaker evidence for a protective effect of smoking. Hypertension was associated with TGA only in more severe stages, while dyslipidemia was not related. In view of these findings, a novel pathophysiological hypothesis is proposed, in which the functional interactions of Angiotensin-II type-1 and N-methyl-D-aspartate receptors are of pivotal importance. The whole body of clinical evidence (nature of precipitating events, associations with migraine, gender-based association patterns) was integrated.
Transient global amnesia
2020, FMC Formacion Medica Continuada en Atencion Primaria
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  La edad (>50 años) es el único factor de riesgo identificado con claridad.
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  El sustrato anatómico de la disfunción neurológica es el lóbulo temporal medial.
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  La patogenia continúa sin certezas. Se barajan como teorías: isquemia arterial, congestión venosa y migraña, pero ninguna de ellas explica completamente los hallazgos clínicos.
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  El trastorno clínicamente se caracteriza por la irrupción de un fallo en la memoria anterógrada, por lo que el paciente está desorientado en lugar y hará preguntas reiteradas sobre dónde está y por qué está ahí. Puede haber un grado variable de amnesia retrógrada. Otras funciones cognitivas y ejecutivas permanecen inalteradas. No hay pérdida de conciencia. Se resuelve tras unas horas.
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  Los hallazgos clínicos son diferentes de otras entidades con las que procede hacer diagnóstico diferencial: ictus, crisis comiciales, encefalopatías tóxico-metabólicas y delírium.
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  Los pacientes con amnesia global transitoria deben ser observados hasta que la clínica se resuelva. En su diagnóstico diferencial pueden precisarse pruebas complementarias: analíticas para evaluar intoxicación, infección y alteraciones metabólicas, así como pruebas de neuroimagen.
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  El pronóstico es bueno y el riesgo de recurrencia, bajo. No requiere tratamiento.
Recurrent transient global amnesia associated with internal jugular vein thrombosis
2019, Journal of the Neurological Sciences
Vascular Risk Factors and Internal Jugular Venous Flow in Transient Global Amnesia: A Study of 165 Japanese Patients
2017, Journal of Stroke and Cerebrovascular Diseases
The etiology of transient global amnesia (TGA) remains unclear. We studied the pathophysiology of TGA in 165 Japanese patients.
TGA was diagnosed in hospitalized patients from 2004 to 2015. We analyzed clinical characteristics, magnetic resonance imaging findings, and maximum intima-media thickness of the common carotid artery, and the reflux of internal jugular venous (IJV) flow by ultrasonography, and statistically compared patients with TGA with age-matched and sex-matched patients who have had a transient ischemic attack (TIA), small-vessel occlusion (SVO), and normal controls (each group, N = 165).
Patients with TGA showed lower prevalence of vascular risk factors than patients with TIA and SVO did. Eleven patients (6.7%) had 2 episodes of TAG, but specific clinical variables could not be recognized in these patients. The maximum intima-media thickness was significantly thinner in TGA (1.1 ± .7 mm) than in SVO (1.6 ± .9 mm; P = .001). The percentages of cases whose IJV flow reflux was increased by Valsalva maneuver showed no difference (P = .573) between TGA (26.0 %) and SVO (29.4%). MR diffusion-weighted imaging yielded small hyperintense signals in the hippocampus in 64 of 90 (71.1%) patients between 24 and 72 hours. Potential precipitating specific factors or events before the attacks could be recognized in 40 cases (24.2%) of 165 patients.
Arterial ischemia and IJV flow reflux might not contribute to TGA pathophysiology. The vulnerability of the hippocampus to physical or emotional stress might be suspected as an underlying mechanism in some patients with TGA.
A Healthy Woman with Sudden Memory Loss
2017, Journal of Emergency Medicine
Long-Term Outcome in Patients With Transient Global Amnesia: A Population-Based Study
2017, Mayo Clinic Proceedings
To study the long-term risk of cerebrovascular events, seizures, and cognitive impairment in patients with transient global amnesia (TGA).
Data for all patients diagnosed with possible TGA in Olmsted County, Minnesota, between January 1, 1985, through December 31, 2010, were retrieved from the Rochester Epidemiology Project database. Transient global amnesia was defined clinically. End points were cerebrovascular event (stroke or transient ischemic attack), seizure, or cognitive impairment (mild cognitive impairment or dementia) during follow-up. End points were studied using Kaplan-Meier survival plots and log-rank test.
A total of 221 patients with TGA were identified and 221 age- and sex-matched controls were included in the analysis. The mean duration of follow-up was 12 years in both groups (range, 0.07-29.93). Prevalence of vascular risk factors and history of seizures were similar between both groups. Previous migraine was more common in the TGA group (42 patients [19.1%] vs 12 patients [5.4%]; P<.001). There was no statistically significant difference between survival curves for the TGA group and the control group using time to any type of cerebrovascular event (log-rank P=.30), time to seizures event (log-rank P=.55), and time to cognitive impair event (log-rank P=.88) as end points. The TGA recurrence occurred in 5.4% of patients after a median interval of 4.21 years (interquartile range, 2.82-8.44). Modified Rankin scale and death rates at last follow-up were also similar between both groups.
Our findings indicate that having an episode of TGA does not increase the risk of subsequent cerebrovascular events, seizures, or cognitive impairment.

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Research LettersDisturbance of venous flow patterns in patients with transient global amnesia

Summary

Lancet

Syndromes of transient amnesia: towards a classification: a study of 153 cases

J Neurol Neurosurg Psychiatry

Research Letters
Disturbance of venous flow patterns in patients with transient global amnesia