Transient global amnesia associated with sildenafil use: report of one case / Amnesia global transitoria asociada al uso de sildenafil: informe de un caso

ABSTRACT A 69 years old male with erectile dysfunction lasting 2 years, took 50 mg of sildenafil for having sex with his wife at about 6 o'clock in the morning. One hour later his wife detected that he had an anterograde memory impairment: this was interpreted as a confusional state. The neurological examination suggested a transient global amnesia (TGA). EEG and cerebral magnetic resonance imaging were non-informative and memory deficits resolved within 24 h. Therefore, a TGA was diagnosed. Since no other trigger was detectable, sildenafil was deemed responsible for its occurrence,

Se reporta el caso de un individuo de sexo masculino de 69 años con disfunción eréctil, que ingiere 50 mg de sildenafil con objetivo de facilitar el mantener relaciones sexuales con su esposa. Una hora después, su esposa nota que su marido presenta una alteración de su memoria anterógrada, lo que fue interpretado como un estado confusional. Evaluado clínicamente su examen neurológico es sugerente de una amnesia transitoria anterógrada. El EEG y las imágenes por resonancia magnética no muestran hallazgos significativos y el déficit de memoria remite dentro de 24 h. en vista de su evolución, se diagnostica una amnesia global transitoria. Como no se identifica otro gatillante, se consideró que el cuadro fue causado por sildenafil..

Transient global amnesia: clinical features and prognostic factors suggesting recurrence / Amnesia global transitoria: características clínicas y factores pronósticos sugestivos de recurrencia

ABSTRACT The risk of recurrence of new amnesia events in patients having previously experienced transient global amnesia (TGA) ranges between 2.9-23.8%. Objective: Our objective was to search for recurrence predictors in TGA patients. Methods: Retrospective analysis to identify recurrence predictors in a cohort of 203 TGA patients from a single center in Buenos Aires, Argentina, diagnosed between January 2011 and March 2017 Clinical features and complementary studies (laboratory results, jugular vein Doppler ultrasound and brain MRI) were analyzed. Comparison between patients with recurrent versus single episode TGA was performed, applying a multivariate logistic regression model. Results: Mean age at presentation was 65 years (20-84); 52% were female. Median time elapsed between symptom onset and ER visit was two hours, with the average episode duration lasting four hours. Mean follow-up was 22 months. Sixty-six percent of patients referred to an identifiable trigger. Jugular reflux was present in 66% of patients; and 22% showed images with hippocampus restriction on diffusion-weighted MRI. Eight percent of patients had TGA recurrence. Patients with recurrent TGA had a more frequent history of migraine than patients without recurrence (37.5% vs. 14%; p = 0.03). None of the other clinical characteristics and complementary studies were predictors of increased risk of recurrence. Conclusions: Patients with migraine may have a higher risk of recurrent TGA. None of the other clinical characteristics evaluated allowed us to predict an increased risk of recurrence. Although the complementary studies allowed us to guide the diagnosis, they did not appear to have a significant impact on the prediction of recurrence risk.

RESUMEN El riesgo de recurrencia de nuevos eventos de amnesia en pacientes que han experimentado previamente Amnesia Global Transitoria (AGT) oscila entre el 2.9-23.8%. Objetivo: Nuestro objetivo fue buscar predictores de recurrencia en pacientes con AGT. Métodos: Análisis retrospectivo de una cohorte de 203 pacientes con AGT de un único centro en Buenos Aires, Argentina, diagnosticados entre enero-2011 y marzo-2017 Se analizaron las características clínicas y los estudios complementarios (laboratorio, Doppler de vena yugular y RM encéfalo). Se comparó el grupo de AGT recurrente versus episodio único, aplicando un modelo de regresión logística multivariada. Resultados: la edad promedio de presentación fue de 65 años (20-84); 52% mujeres. La mediana del tiempo transcurrido entre el inicio de los síntomas y la visita a la sala de emergencia fue de 2 horas, con una duración promedio del episodio de 4 horas. El seguimiento medio fue de 22 meses. 66% de los pacientes tuvieron un desencadenante identificable. El reflujo yugular estuvo presente en el 66% de los pacientes y el 22% mostró imágenes restrictivas en DWI a nivel hipocampal. 8% de los pacientes presentaron recurrencia. Los pacientes con AGT recurrente tuvieron un historial de migraña más frecuente (37.5% vs. 14%; p=0.03). Ninguna de las otras características clínicas y estudios complementarios fueron predictores de mayor riesgo de recurrencia. Conclusiones: los pacientes con migraña pueden tener un mayor riesgo de recurrencia de AGT. Ninguna de las otras características clínicas evaluadas nos permitió predecir un mayor riesgo de recurrencia. Aunque los estudios complementarios nos permitieron orientar el diagnóstico, no pareció tener un impacto significativo en la predicción del riesgo de recurrencia.

Impaired Smooth Pursuit During Transient Global Amnesia

BACKGROUND AND PURPOSE: During transient global amnesia (TGA), selective impairment of episodic memory is assumed to occur due to alteration in the neuronal network between the hippocampus and parietooccipital cortices that also include a hub for smooth pursuit (SP) eye movements. This study aimed to determine whether SP is impaired during TGA, and to identify any anatomical and functional linkage present between the oculomotor and memory systems. METHODS: Within a median of 1.0 day of TGA, horizontal SP was evaluated in 145 patients with a target moving at peak velocities of 10°/s and 20°/s. The average SP gains of patients were compared with those of the age-matched controls. RESULTS: The patients with TGA showed lower SP gains in both directions for both peak target velocities. While the normal controls showed symmetric SP in the rightward and leftward directions, in the TGA patients the SP gain was lower during rightward than leftward SP regardless of bilaterality or the side of the lesions. CONCLUSIONS: The cortical regions processing information about visual motion appeared to be affected during or soon after an amnestic episode of TGA, and more so in the right hemisphere. This means that disturbed processing of dynamic visual information may be related to the impaired spatial orientation observed during TGA.

Transient Global Amnesia Developed after Zolpidem Intake

We report two patients who complained of transient anterograde amnesia and repetitive questioning, that developed after taking zolpidem and lasted for several hours. The clinical manifestations of these patients fulfill the clinical criteria for transient global amnesia (TGA). The typical clinical manifestation of TGA following the consumption of zolpidem suggests a possible relationship associated with its drug mechanism.

Transient Global Amnesia after Gastroscopy

No abstract available.

A Case of Posterior Reversible Encephalopathy Syndrome with Similar Symptoms as Transient Global Amnesia

No abstract available.

Amnésia global transitória: epidemiologia, fisiopatologia, clínica e terapêutica / Global transient amnesia: epidemiology, pathophysiology, clinical features and therapeutics

A amnésia global transitória (AGT) é um quadro súbito de amnésia global, não acompanhada de outros déficits neurológicos, com duração de duas a 24 horas e cuja recuperação se dá espontaneamente. A incidência na população geral está estimada em 5-10 casos/100.000 pessoas/ano. Diferentes mecanismos fisiopatológicos, como fatores vasculares ou epiléticos, têm sido propostos para explicar a AGT, sendo consensual que haja acometimento transitório de regiões do hipocampo e do giro para-hipocampal. Além da amnésia anterógrada acompanhada por amnésia retrógrada, o paciente apresenta desorientação (tempo/espaço), estando preservadas outras habilidades cognitivas, como memória semântica e capacidades visuo-construtivas. Esses déficits tendem a remitir após 24h, sendo o prognóstico favorável na maioria dos casos. O diagnóstico diferencial de AGT é amplo e diversas condições clínicas, como eventos cérebro-vasculares, epilepsias, infecções e intoxicações podem mimetizá-lo, de modo que uma investigação clínica cuidadosa é imperativa. As recorrências não são frequentes nos quadros típicos. A AGT não requer tratamento específico, mas devem ser tratados fatores de risco cardiovascular eventualmente identificados durante a propedêutica de AGT. O clínico deve esclarecer o paciente a respeito do caráter benigno da AGT. Estudos com seguimento longitudinal dos pacientes são necessários para maior compreensão dos mecanismos fisiopatológicos da AGT e para melhor compreensão clínica e neuro- biológica dos déficits cognitivos apresentados por esses pacientes.

Global transient amnesia (GTA) is a clinical syndrome characterized by the sudden onset of anterograde and retrograde amnesia, without permanent neurological deficits, and which presents complete remission spontaneously within 2 to 24 hours. The incidence of GTA in the general population ranges from 5 to 10 cases per 100.000 individuals/ year. Different pathophysiological mechanisms have been proposed for GTA, such as vascular or epileptic factors, and it is consensual that there is transitory involvement of hippocampal and parahippocampal gyri in this condition. In addition to anterograde and retrograde amnesia, GTA patients typically present time-space disorientation, with the preservation of other cognitive abilities, such as semantic memory and visuoconstructive capacities. The differential diagnosis includes stroke, epilepsy, infections and intoxication, and a careful clinical investigation is essential to establish the GTA diagnosis. Recurrence is uncommon in typical cases and, in general, no specific treatment is required. However, clinical investigation of GTA may eventually disclose cardiovascular risk factors; these factors should be treated when identified. GTA is considered a benign condition, with good clinical and cognitive prognostics in most of the cases. More studies are needed to advance the current knowledge on the pathophysiology and on the neural basis of the transitory cognitive impairment observed in GTA.

Transient Global Amnesia Caused by Bilateral Medial Temporal-Lobe Infarction

No abstract available.

Seasonal Variation in the Incidence of Transient Global Amnesia in South Korea

No abstract available.

Repetitive Questioning and Writing in a Patient with Transient Global Amnesia

No abstract available.

Hippocampal Lesions of Diffusion Weighted Magnetic Resonance Image in Patients with Headache without Symptoms of Transient Global Amnesia

BACKGROUND: The dot-like hippocampal signal intensity in diffusion-weighted MR images is well-known as a characteristic imaging feature in transient global amnesia, a neurological syndrome in which sudden forward-and-backward memory loss occurs that is slowly recovered within 24 hours. We here report on patients with this dot-like hippocampal hyperintensity who did not present with anterograde amnesia except for headaches. CASE REPORT: Two women without a specific medical history presented with sudden-onset headaches on the same day. Neither had any trauma or infection history before the symptom or any sudden emotional or postural changes. Brain MRI showed tiny hippocampal high signal intensity on diffusion-weighted images (DWI). CONCLUSIONS: Dot-like hippocampal lesions seen on DWI may be present without memory impairment, and more studies are needed to determine whether there is any association with headache as in this case.

Comparison of Clinical Characteristics between Transient Global Amnesia with and without Acute Focal Lesion in Hippocampus

BACKGROUND: Transient global amnesia (TGA) might be related to an ischemic event with characteristic findings in diffusion-weighted images (DWIs). However, acute lesions are uncommon. The aim of this study was to identify any clinical or radiological differences between TGA patients with and without acute lesions. METHODS: From January 2010 through March 2015, we identified retrospectively TGA patients with DWIs within 7 days from onset. According to the presence of an acute lesion in the hippocampus, clinical features, vascular risk factors, electroencephalography (EEG) findings, and the regional perfusion status in single-photon-emission computed tomography (SPECT) images were compared. RESULTS: Of 57 TGA patients (mean age=60.5 years; 40 females), 19 patients (33.3%) had acute focal lesions in the hippocampus (3.53±0.74 mm, mean±SD). In terms of clinical features, the symptom duration was shorter in the lesion-negative group than in the lesion-positive group (mean=5 hours, interquartile range [IQR]=2-9 hours vs. mean=8 hours, IQR=5-13.5 hours; p=0.072). However, there were no differences between TGA patients with and without DWI lesions in cerebrovascular risk factors, laboratory results, or EEG findings. In 6 of 22 patients who underwent cerebral SPECT (2 of 9 DWI lesions and 4 of 13 without lesions), mild perfusion defects were exhibited without significant differences in both medial temporal regions and in the left frontal and left frontotemporal regions. CONCLUSIONS: Symptom duration was the only clinical difference-including perfusion defects and epileptic evidence-between TGA patients with and without DWI lesions. This suggests that there is a low probability of hypoperfusion or focal seizure in TGA patients without acute lesions.

Hippocampal Hyperintensities on Diffusion-Weighted MRI without Transient Global Amnesia

Dot-like hippocampal hyperintensities on diffusion-weighted magnetic resonance imaging (MRI) have been reported as an interesting imaging finding of transient global amnesia (TGA). We report three patients with such dot-like hippocampal hyperintensities who did not present with anterograde amnesia. Episodes associated with the Valsalva maneuver such as nausea or vomiting might have produced the dot-like hippocampal hyperintensities in these patients. However, depending on the individual susceptibility to hippocampal lesions, clinical symptoms of TGA might not be present even when hippocampal lesions are present.

Transient global amnesia associated with toxocariasis and secondary hypereosinophilia

Toxocariasis is an important cause of secondary hypereosinophilia in Korea. Here, we describe a rare case of toxocariasis presenting as transient global amnesia due to secondary hypereosinophilia. A 44-year-old male visited the Emergency Department (ED) for transient global amnesia. He ate raw cow liver and omasum 2 weeks before the ED visit. The initial peripheral blood eosinophil count was 15,250/µL and serologic test for serum specific IgG antibodies to Toxocara canis larval antigen was positive. Radiologic studies revealed multiple small embolic infarctions of brainwithout cardioembolic sources or vascular abnormalities. He was treated with systemic corticosteroid, and neither neurologic deficit nor motor deficit was left. In our current case, the patient have a history of frequently eating raw cow liver and omasum, and his total IgE level was extremely high (>5,000 IU/mL). Thus, the patient was diagnosed as having toxocariasis and secondary hypereosinophilia. Toxocariasis should be considered in the differential diagnosis in patients with eosinophilia and atypical neurologic symptoms, such as transient amnesia.

Seasonal Changes in the Incidence of Transient Global Amnesia

BACKGROUND AND PURPOSE: Transient global amnesia (TGA) is a stereotypic condition characterized by anterograde and retrograde amnesia that typically resolves within 24 hours. The pathophysiology of TGA is still unclear. We noted that patients hospitalized with TGA tend to appear in seasonal clusters, and decided to investigate this phenomenon. METHODS: Every patient with acute presentation of amnesia at our medical center is hospitalized for observation and evaluation. We reviewed the monthly occurrence of TGA in our patient population between 2000 and 2014, and compared this to non-TGA hospitalizations during the same time period. RESULTS: During the analysis period, 154 patients who met the criteria for TGA were hospitalized, as well as 259,007 non-TGA hospitalizations. The annual occurrence of TGA ranged from 5 to 16 hospitalizations. There were 91 TGA events in women and 63 in men, in subjects aged 62.8±10.6 years (mean±SD). The incidence was maximal during December [odds ratio (OR)=2.83, 95% confidence interval (CI)=1.20–6.67] and March (OR=2.77, 95% CI=1.17–6.56), and minimal from April to August. The incidence exhibited an increase followed by a decrease from October to February. A seasonal trend was observed as well, with incidence peaks occurring in winter (OR=1.82, 95% CI=1.12–2.96) and spring (OR=1.80, 95% CI=1.10–2.94). CONCLUSIONS: Our findings suggest that the incidence of TGA exhibits seasonal variations. This observation may help to improve the understanding of the pathophysiology underlying TGA.

Recurrent Transient Global Amnesia in a Hot and Humid Machinery Room

Transient global amnesia (TGA) is characterized by abrupt onset temporary dysfunction of anterograde and retrograde amnesia without other neurologic deficits. We encountered a 53-year-old man who developed recurrent TGA while working in a hot and humid machinery room (33degrees C and 64% relative humidity). Heat exposure and physical exertion may facilitate the leakage of cytokines into the systemic circulation so as to cause a cerebral endothelial insult. Functional insufficiency of the hippocampus and its connections caused by physical and environmental factors may be related to recurrent attacks.

Persistência de imagem de hiperintensidade no hipocampo após episódio de amnésia global transitória / Persistence of hyperintensity image in the hippocampus after an episode of transient global amnesia

A patogenia da amnésia global transitória (AGT) continua obscura. Estudos recentes demonstraram que, em alguns pacientes, a sequência de difusão (DWI) da ressonância magnética pode revelar apresença de sinal pequeno e pontual hipersinal no hipocampo, após a fase aguda do episódio. Esse sinal é principalmente visualizado nas primeiras 6 horas do início do evento, sendo 114 horas o tempo máximo que foi registrado até o momento. Estamos apresentando um caso em que essa imagem persistiu por 11 dias após o episódio. Discutem-se as conhecidas causas, as teorias da patogenia da AGT e a possível conexão entre um efeito vascular e a depressão alastrante, como relatada na enxaqueca com aura.

The pathogenesis of transient global amnesia (TGA) remains obscure.Recent studies revealed that small and punctate signal on diffusion-weighted imaging (DWI) in the hippocampus after the post-acute phase. This signal is mainly seen in the first 6 hours of the onset of the event, and so far the maximum time registered was 114 hours. We present one case where this image persisted for 11 days after the episode. Known causes, theories on pathogenesis of TGA and a possible relation between a vascular mechanism and the spreading depression, as reported in migraine with aura, are discussed.

Anterior portion of the cingulate gyrus: A novel location for transient global amnesia? / Porção anterior do giro do cíngulo: Uma nova localização para amnésia global transitória?

Transient global amnesia (TGA) is characterized by abrupt transient loss of anterograde memory, lasting up to 24 hours, and no other focal neurological signs. We report the case of a right-handed 71-year-old female patient who presented temporal-spatial disorientation 5 minutes after ingestion of 1000 ml of iodinated contrast. The patient had mild temporal-spatial disorientation, with significant deficit in anterograde memory. After 12 hours under observation, the patient progressed to gradual improvement and was discharged. A reevaluation after 15 days showed normal cortical functions, score on mini-mental state exam of 30, and unaffected working and recall memory. MRI performed 48 hours after the event showed hypersignal in the diffusion sequence in the anterior portion of the cingulate gyrus, with hypointense signal in MAP/ ADC, confirming a finding consistent with TGA. No previous reports in the literature have described the location affected in this patient, rendering it a novel site consistent with this diagnosis.

Amnésia global transitória (TGA) é caracterizada por perda transitória abrupta de memória anterógrada, com duração de até 24 horas e sem outros sinais neurológicos focais. Relatamos o caso de uma paciente de 71 anos de idade, destra, que apresentou desorientação temporal e espacial depois de 5 minutos após a ingestão de 1.000 ml de contraste iodado. A paciente teve desorientação temporoespacial moderada, com déficit significativo de memória anterógrada. Depois de permanecer 12 horas sob observação, progrediu para melhoria gradual e recebeu alta. A nova avaliação após 15 dias mostrou funções corticais normais, com mini-exame mental de 30, com memória executiva e de evocação preservadas. A ressonância magnética realizada 48 horas após o evento mostrou hipersinal na sequência difusão na porção anterior do giro do cíngulo, com hipossinal em MAPA/ADC, confirmando achado compatível com TGA. Não há relato na literatura descrevendo alteração no mesmo local que esta paciente, tornando-se, portanto, um possível novo local compatível com diagnóstico de TGA.