Brain Topography

, Volume 31, Issue 3, pp 468–476 | Cite as

Decreased Metabolism in the Posterior Medial Network with Concomitantly Increased Metabolism in the Anterior Temporal Network During Transient Global Amnesia

  • SangHak Yi
  • Young Ho Park
  • Jae-Won Jang
  • Jae-Sung Lim
  • In Kook Chun
  • SangYun Kim
Original Paper


Perturbation of corticohippocampal circuits is a key step in the pathogenesis of transient global amnesia. We evaluated the spatial distribution of altered cerebral metabolism to determine the location of the corticohippocampal circuits perturbed during the acute stage of transient global amnesia. A consecutive series of 12 patients with transient global amnesia who underwent 18F-fluorodeoxyglucose positron emission tomography within 3 days after symptom onset was identified. We used statistical parametric mapping with two contrasts to identify regions of decreased and increased brain metabolism in transient global amnesia patients compared with 25 age-matched controls. Transient global amnesia patients showed hypometabolic clusters in the left temporal and bilateral parieto-occipital regions that belong to the posterior medial network as well as, hypermetabolic clusters in the bilateral inferior frontal regions that belong to the anterior temporal network. The posterior medial and anterior temporal networks are the two main corticohippocampal circuits involved in memory-guided behavior. Decreased metabolism in the posterior medial network might explain the impairment of episodic memory observed during the acute stage of transient global amnesia. Concomitant increased metabolism within the anterior temporal network might occur as a compensatory mechanism.


Hippocampus Positron emission tomography Anterior temporal network Posterior medial network Transient global amnesia 


Compliance with Ethical Standards

Conflict of interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical Approval

The study protocol was approved by the Institutional Review Board of Seoul National University Bundang Hospital. Informed consent was not required due to the retrospective nature of the study and minimal risk to participants.


  1. Baron JC, Petit-Taboué MC, Le Doze F, Desgranges B, Ravenel N, Marchal G (1994) Right frontal cortehypometabolism in transient global amnesia. A PET study. Brain 117:545–552. doi: 10.1093/brain/117.3.545 CrossRefPubMedGoogle Scholar
  2. Bartsch T, Butler C (2013) Transient amnesic syndromes. Nat Rev Neurol 9:86–97. doi: 10.1038/nrneurol.2012.264 CrossRefPubMedGoogle Scholar
  3. Bartsch T, Deuschl G (2010) Transient global amnesia: functional anatomy and clinical implications. Lancet Neurol 9:205–214. doi: 10.1016/S1474-4422(09)70344-8 CrossRefPubMedGoogle Scholar
  4. Burle B, Spieser L, Roger C, Casini L, Hasbroucq T, Vidal F (2015) Spatial and temporal resolutions of EEG: is it really black and white? A scalp current density view. Int J Psychophysiol 97:210–220. doi: 10.1016/j.ijpsycho.2015.05.004 CrossRefPubMedPubMedCentralGoogle Scholar
  5. Burwell RD (2000) The parahippocampal region: corticocortical connectivity. Ann N Y Acad Sci 911:25–42. doi: 10.1111/j.1749-6632.2000.tb06717.x CrossRefPubMedGoogle Scholar
  6. Chung YA, Jeong J, Yang DW, Kang BJ, Kim SH, Chung SK, Sohn HS, Peterson BS (2009) A Tc-99m SPECT study of regional cerebral blood flow in patients with transient global amnesia. Neuroimage 47:50–55. doi: 10.1016/j.neuroimage.2008.11.011 CrossRefPubMedGoogle Scholar
  7. Cohen J (1992) A power primer. Psychol Bull 112:155–159. doi: 10.1037/0033-2909.112.1.155 CrossRefPubMedGoogle Scholar
  8. Cohen AD, Price JC, Weissfeld LA, James J, Rosario BL, Bi W, Nebes RD, Saxton JA, Snitz BE, Aizenstein HA, Wolk DA, Dekosky ST, Mathis CA, Klunk WE (2009) Basal cerebral metabolism may modulate the cognitive effects of Abeta in mild cognitive impairment: an example of brain reserve. J Neurosci 29:14770–14778. doi: 10.1523/JNEUROSCI.3669-09.2009 CrossRefPubMedPubMedCentralGoogle Scholar
  9. Eustache F, Desgranges B, Petit-Taboué MC, de la Sayette V, Piot V, Sablé C, Marchal G, Baron JC (1997) Transient global amnesia: implicit/explicit memory dissociation and PET assessment of brain perfusion and oxygen metabolism in the acute stage. J Neurol Neurosurg Psychiatry 63:357–367. doi: 10.1136/jnnp.63.3.357 CrossRefPubMedPubMedCentralGoogle Scholar
  10. Förster A, Al-Zghloul M, Kerl HU, Böhme J, Mürle B, Groden C (2015) Value of dynamic susceptibility contrast perfusion MRI in the acute phase of transient global amnesia. PLoS ONE 10:e0122537. doi: 10.1371/journal.pone.0122537 CrossRefPubMedPubMedCentralGoogle Scholar
  11. Gonzalez-Martinez V, Comte F, de Verbizier D, Carlander B (2010) Transient global amnesia: concordant hippocampal abnormalities on positron emission tomography and magnetic resonance imaging. Arch Neurol 67:510. doi: 10.1001/archneurol.2010.50 CrossRefPubMedGoogle Scholar
  12. Guillery B, Desgranges B, de la Sayette V, Landeau B, Eustache F, Baron JC (2002) Transient global amnesia: concomitant episodic memory and positron emission tomography assessment in two additional patients. Neurosci Lett 325:62–66. doi: 10.1016/S0304-3940(02)00233-1 CrossRefPubMedGoogle Scholar
  13. Heiss WD, Pawlik G, Holthoff V, Kessler J, Szelies B (1992) PET correlates of normal and impaired memory functions. Cerebrovasc Brain Metab Rev 4:1–27PubMedGoogle Scholar
  14. Hodges JR, Warlow CP (1990) Syndromes of transient amnesia: towards a classification. A study of 153 cases. J Neurol Neurosurg Psychiatry 53:834–843. doi: 10.1136/jnnp.53.10.834 CrossRefPubMedPubMedCentralGoogle Scholar
  15. Hutchinson JB, Uncapher MR, Wagner AD (2009) Posterior parietal cortex and episodic retrieval: convergent and divergent effects of attention and memory. Learn Mem 16:343–356. doi: 10.1101/lm.919109 CrossRefPubMedPubMedCentralGoogle Scholar
  16. Jang JW, Park YH, Park SY, Wang MJ, Lim JS, Kim SH, Chun IK, Yang Y, Kim S (2015) Longitudinal cerebral perfusion change in transient global amnesia related to left posterior medial network disruption. PLoS ONE 10:e0145658. doi: 10.1371/journal.pone.0145658 CrossRefPubMedPubMedCentralGoogle Scholar
  17. 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 10:238–241CrossRefPubMedGoogle Scholar
  18. Kim MJ, Lee KM, Son YD, Jeon HA, Kim YB, Cho ZH (2012) Increased basal forebrain metabolism in mild cognitive impairment: an evidence for brain reserve in incipient dementia. J Alzheimers Dis 32:927–938. doi: 10.3233/JAD-2012-120133 PubMedGoogle Scholar
  19. Kim J, Kwon Y, Yang Y, Jang IM, Chang Y, Park YH, Jang JW, Kim JH, Kim S (2014) Clinical experience of modified diffusion-weighted imaging protocol for lesion detection in transient global amnesia: an 8-year large-scale clinical study. J Neuroimaging 24:331–337. doi: 10.1111/jon.12021 CrossRefPubMedGoogle Scholar
  20. Kwon Y, Yang Y, Jang JW, Park YH, Kim J, Park SH, Kim S (2014) Left dominance of EEG abnormalities in patients with transient global amnesia. Seizure 23:825–829. doi: 10.1016/j.seizure.2014.06.014 CrossRefPubMedGoogle Scholar
  21. La Joie R, Landeau B, Perrotin A, Bejanin A, Egret S, Pélerin A, Mézenge F, Belliard S, de La Sayette V, Eustache F, Desgranges B, Chételat G (2014) Intrinsic connectivity identifies the hippocampus as a main crossroad between Alzheimer’s and semantic dementia-targeted networks. Neuron 81:1417–1428. doi: 10.1016/j.neuron.2014.01.026 CrossRefPubMedGoogle Scholar
  22. Laloux P, Brichant C, Cauwe F, Decoster P (1992) Technetium-99m HM-PAO single photon emission computed tomography imaging in transient global amnesia. Arch Neurol 49:543–546. doi: 10.1001/archneur.1992.00530290131022 CrossRefPubMedGoogle Scholar
  23. Lampl Y, Sadeh M, Lorberboym M (2004) Transient global amnesia—not always a benign process. Acta Neurol Scand 110:75–79. doi: 10.1111/j.1600-0404.2004.00275.x CrossRefPubMedGoogle Scholar
  24. Libby LA, Ekstrom AD, Ragland JD, Ranganath C (2012) Differential connectivity of perirhinal and parahippocampal cortices within human hippocampal subregions revealed by high-resolution functional imaging. J Neurosci 32:6550–6560. doi: 10.1523/JNEUROSCI.3711-11.2012 CrossRefPubMedPubMedCentralGoogle Scholar
  25. Lin KN, Liu RS, Yeh TP, Wang SJ, Liu HC (1993) Posterior ischemia during an attack of transient global amnesia. Stroke 24:1093–1095. doi: 10.1161/01.STR.24.7.1093 CrossRefPubMedGoogle Scholar
  26. Matsuda H, Higashi S, Tsuji S, Sumiya H, Miyauchi T, Hisada K, Yamashita J (1993) High resolution Tc-99m HMPAO SPECT in a patient with transient global amnesia. Clin Nucl Med 18:46–49. doi: 10.1097/00003072-199301000-00011 CrossRefPubMedGoogle Scholar
  27. Murray BD, Kensinger EA (2014) The route to an integrative associative memory is influenced by emotion. PLoS ONE 9:e82372. doi: 10.1371/journal.pone.0082372 CrossRefPubMedPubMedCentralGoogle Scholar
  28. Park YH, Jang JW, Yang Y, Kim JE, Kim S (2013) Reflections of two parallel pathways between the hippocampus and neocortex in transient global amnesia: a cross-sectional study using DWI and SPECT. PLoS ONE 8:e67447. doi: 10.1371/journal.pone.0067447 CrossRefPubMedPubMedCentralGoogle Scholar
  29. Park YH, Jeong HY, Jang JW, Park SY, Lim JS, Kim JY, Im CH, Ahn S, Park SH, Kim S (2016) Disruption of the posterior medial network during the acute stage of transient global amnesia: a preliminary study. Clin EEG Neurosci 47:69–74. doi: 10.1177/1550059414543684 CrossRefPubMedGoogle Scholar
  30. Ranganath C, Ritchey M (2012) Two cortical systems for memory-guided behaviour. Nat Rev Neurosci 13:713–726. doi: 10.1038/nrn3338 CrossRefPubMedGoogle Scholar
  31. Ryoo I, Kim JH, Kim S, Choi BS, Jung C, Hwang SI (2012) Lesion detectability on diffusion-weighted imaging in transient global amnesia: the influence of imaging timing and magnetic field strength. Neuroradiology 54:329–334. doi: 10.1007/s00234-011-0889-4 CrossRefPubMedGoogle Scholar
  32. Sakashita Y, Kanai M, Sugimoto T, Taki S, Takamori M (1997) Changes in cerebral blood flow and vasoreactivity in response to acetazolamide in patients with transient global amnesia. J Neurol Neurosurg Psychiatry 63:605–610. doi: 10.1136/jnnp.63.5.605 CrossRefPubMedPubMedCentralGoogle Scholar
  33. Sestieri C, Shulman GL, Corbetta M (2017) The contribution of the human posterior parietal cortex to episodic memory. Nat Rev Neurosci 18:183–192. doi: 10.1038/nrn.2017.6 CrossRefPubMedPubMedCentralGoogle Scholar
  34. Stern Y (2002) What is cognitive reserve? Theory and research application of the reserve concept. J Int Neuropsychol Soc 8:448–460. doi: 10.1017/S1355617702813248 CrossRefPubMedGoogle Scholar
  35. Stern Y, Alexander GE, Prohovnik I, Mayeux R (1992) Inverse relationship between education and parietotemporal perfusion deficit in Alzheimer’s disease. Ann Neurol 32:371–375. doi: 10.1002/ana.410320311 CrossRefPubMedGoogle Scholar
  36. Takeuchi R, Yonekura Y, Matsuda H, Nishimura Y, Tanaka H, Ohta H, Sakahara H, Konishi J (1998) Resting and acetazolamide-challenged technetium-99m-ECD SPECT in transient global amnesia. J Nucl Med 39:1360–1362PubMedGoogle Scholar
  37. Wang MJ, Yi S, Han JY, Park SY, Jang JW, Chun IK, Giau VV, Bagyinszky E, Lim KT, Kang SM, An SS, Park YH, Youn YC, Kim S (2016) Analysis of cerebrospinal fluid and [11C]PIB PET biomarkers for Alzheimer’s disease with updated protocols. J Alzheimers Dis 52:1403–1413. doi: 10.3233/JAD-160143 CrossRefPubMedGoogle Scholar
  38. Xia M, Wang J, He Y (2013) BrainNet viewer: a network visualization tool for human brain connectomics. PLoS ONE 8:e68910. doi: 10.1371/journal.pone.0068910 CrossRefPubMedPubMedCentralGoogle Scholar
  39. Yang Y, Kim JS, Kim S, Kim YK, Kwak YT, Han IW (2009) Cerebellar hypoperfusion during transient global amnesia: an MRI and oculographic study. J Clin Neurol 5:74–80. doi: 10.3988/jcn.2009.5.2.7 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • SangHak Yi
    • 1
  • Young Ho Park
    • 2
  • Jae-Won Jang
    • 3
  • Jae-Sung Lim
    • 4
  • In Kook Chun
    • 5
  • SangYun Kim
    • 2
  1. 1.Department of NeurologyWonkwang University School of Medicine and Regional Cardiocerebrovascular CenterIksan-siSouth Korea
  2. 2.Department of Neurology, Seoul National University College of Medicine and Clinical Neuroscience CenterSeoul National University Bundang HospitalSeongnam-siSouth Korea
  3. 3.Department of Neurology, School of MedicineKangwon National UniversityChuncheon-siSouth Korea
  4. 4.Department of NeurologyHallym University Sungim HospitalAnyang-siSouth Korea
  5. 5.Department of Nuclear Medicine, School of MedicineKangwon National UniversityChuncheon-siSouth Korea

Personalised recommendations