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Acute neurological disease as a trigger or co-occurrence of transient global amnesia: a case series and systematic review

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Abstract

Background

Transient global amnesia (TGA) represents a benign neurological syndrome of unknown pathophysiology, often accompanied by vanishing hippocampal punctate lesions on diffusion-weighted imaging (hippocampal punctate diffusion lesion, HPDL). The recent literature suggests that TGA may be triggered by acute neurological conditions.

Objective

To study patients with TGA triggered by an acute neurological disease.

Methods

We retrospectively reviewed patients from two neurology centres with TGA (with or without HPDL) in whom an acute neurological condition could be identified as trigger. We also performed a systematic review of the literature of this situation using predefined search terms.

Results

We identified 38 patients (median age 62 years, 55.3% female): 6 from our centres and 32 from the literature. Acute neurovascular diseases that preceded or were associated with TGA included ischemic and haemorrhagic strokes, convexity subarachnoid haemorrhage, and reversible cerebral vasoconstriction syndrome. As non-vascular acute neurological diseases, we identified migraine and peripheral-origin vertigo. The clinical manifestation of the neurological trigger showed a variable temporal relation with TGA onset; in some cases preceding and in others co-occurring with TGA manifestation. In some cases, presumed neurological triggers were asymptomatic and diagnosed from the neuroimaging done for the TGA.

Conclusions

Acute vascular and non-vascular neurological events may trigger TGAs or may occur simultaneously. In the first case, such an acute neurological disease may activate direct pathways within the nervous systems leading to TGA, or alternatively elicit a bodily sympathetic overactivity cascade. In the second case, both neurological events may be the result of a common external stressor.

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Data availability

The authors state that the data supporting the findings of this study are available within the article and its supplemental material. Additional anonymized patient-specific data supporting the findings of the study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

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Acknowledgements

We thank Dr. Hahn Y Kim and Dr. Ralph Werner for providing additional patient information [37, 52]; Dr. Ivo Meyer for helping with patient data collection; Dr. Fabrice Dami for calculating the number of transient amnesia patients arriving at the CHUV from 2006 to 2019; and Mrs. Melanie Price Hirt, PhD, for English language correction and editing.

Author information

Author notes

  1. Silvio Piffer and Stefania Nannoni contributed equally.

Authors and Affiliations

  1. Stroke Centre and Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland

    Silvio Piffer, Stefania Nannoni & Patrik Michel

  2. Neurology Unit, Department of Emergency, Santa Chiara Hospital, Trento, Italy

    Silvio Piffer

  3. Stroke Centre EOC, Neurology Department, Neurocentre of Southern Switzerland (NSI), Ospedale Civico, Lugano, Switzerland

    Francesco Maulucci & Carlo W. Cereda

  4. Neuropsychology and Neurorehabilitation Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland

    Valérie Beaud

  5. Leenaards Memory Centre, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland

    Olivier Rouaud

  6. Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland

    Philippe Maeder

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  1. Silvio Piffer
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Contributions

Silvio Piffer: study concept, data collection, literature review, preparation of the manuscript. Stefania Nannoni: study concept, data collection, literature review, preparation of the manuscript. Francesco Maulucci: data collection, critical revision of the manuscript. Valérie Beaud: data collection, critical revision of the manuscript. Olivier Rouaud: critical revision of the manuscript. Carlo W. Cereda: critical revision of the manuscript. Philippe Maeder: interpretation of neuroimaging data, critical revision of the manuscript. Patrik Michel: study concept and supervision, literature review, critical revision of the manuscript.

Corresponding author

Correspondence to Silvio Piffer.

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The authors declare no competing interests.

Ethical approval and informed consent

Patients in our institutions are routinely informed by our institutions about the possibility that their routinely collected clinical and radiological data may be reused for research purposes, with the option of opting-out. None of the patients reviewed for this study refused this general consent. A medical professional not participating in the study anonymized all extracted patient data and removed any potential identifiers, making reidentification impossible without disproportionate efforts. Given that only anonymized data were used for analysis, there was no need for approval by our institutional review boards according to the Swiss Human Research Act.

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Piffer, S., Nannoni, S., Maulucci, F. et al. Acute neurological disease as a trigger or co-occurrence of transient global amnesia: a case series and systematic review. Neurol Sci 43, 5959–5967 (2022). https://doi.org/10.1007/s10072-022-06259-6

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