Transient global amnesia is a sudden syndrome of anterograde and shrinking retrograde memory loss lasting several hours in otherwise healthy adults. The author reviews what is known about the syndrome. 

Transient Global Amnesia

Transient global amnesia (TGA) is a benign, stress-induced neurological syndrome associated with reversible hippocampal dysfunction that manifests as isolated, predominantly anterograde amnesia. Since it is impossible to make a definitive diagnosis of TGA when the patient is admitted to hospital, the primary condition should be interpreted as an acute cerebrovascular accident, which implies a mandatory neuroimaging examination and clarification of the question of thrombolysis according to general principles. When taking a medical history, attention should be paid to the presence of predisposing conditions and triggers: migraine, chronic and acute stress, physical activity, sudden changes in temperature, Valsalva maneuver, coitus, medical procedures. If amnesia does not resolve within 24 hours, a differential diagnosis with stroke, Wernicke–Korsakoff encephalopathy, limbic encephalitis, intoxication and psychogenic (dissociative) amnesia is required. If the symptoms resolve within 24 hours and the classic diagnostic criteria are met, magnetic resonance imaging of the brain in diffusion-weighted mode is performed on days 2 to 4 in order to detect pinpoint zones of diffusion restriction in the hippocampus. If these lesions are visible and a typical medical history is available, the diagnosis of TGA can be made; if no lesions are present, the diagnosis is probable. In the absence of lesions and an atypical history of TGA, differentiation from transient epileptic or dissociative amnesia and transient ischemic attack is required. 

pdf/transient-global-amnesia-ykdpoozbch.pdf

Transient global amnesia

Transient global amnesia. What's in a name?

Background and purpose: Isolated posterior cerebral artery occlusions (iPCAO) were underrepresented in pivotal randomized clinical trial (RCTs) of endovascular thrombectomy (EVT) in ischemic stroke, and the benefit of EVT in this population is still indeterminate. We performed a systematic review and a meta-analysis to compare the safety and efficacy of EVT compared to best medical management (BMM) in patients with iPCAO. Methods: We searched Medline/PubMed, Embase, Web of Science, and the Cochrane databases up to May 2023 for eligible studies reporting outcomes of patients with iPCAO treated with EVT or BMM. We pooled odds ratios (ORs) with corresponding 95% confidence intervals (CI) using a random-effects model. Results: Seven studies involving 2560 patients were included. EVT was associated with significantly higher likelihood of early neurological improvement (OR, 2.31 [95% CI, 1.38–2.91]; p < 0.00001) and visual field normalization (OR, 3.08 [95% CI, 1.76–5.38]; p < 0.0001) compared to BMM. Rates of good functional outcomes (mRS 0–2) were comparable between the two arms (OR, 0.88 [95% CI, 0.70–1.10]; p = 0.26). Symptomatic intracranial hemorrhage (sICH) was comparable between the two groups (OR, 1.94 [95% CI, 0.96–3.93]; p = 0.07). Mortality was also similar between the two groups (OR, 1.36; [95% CI, 0.77–2.42]; p = 0.29). Conclusions: In patients with iPCAO, EVT was associated with visual and early neurological improvement but with a strong trend toward increased sICH. Survival and functional outcomes may be slightly poorer. The role of EVT in iPCAO remains uncertain. Graphical abstract

Endovascular therapy versus best medical management for isolated posterior cerebral artery occlusion: A systematic review and meta-analysis.

Transient Global Amnesia.

Transient global amnesia with unexpected clinical and radiological findings: A case series and systematic review

Purpose: There is little data on the safety and efficacy of endovascular treatment (EVT) in comparison with intravenous thrombolysis (IVT) in acute ischemic stroke due to isolated posterior cerebral artery occlusion (IPCAO). We aimed to investigate the functional and safety outcomes of stroke patients with acute IPCAO treated with EVT (with or without prior bridging IVT) compared to IVT alone. Methods: We did a multicenter retrospective analysis of data from the Swiss Stroke Registry. The primary endpoint was overall functional outcome at 3 months in patients undergoing EVT alone or as part of bridging, compared with IVT alone (shift analysis). Safety endpoints were mortality and symptomatic intracranial hemorrhage. EVT and IVT patients were matched 1:1 using propensity scores. Differences in outcomes were examined using ordinal and logistic regression models. Findings: Out of 17,968 patients, 268 met the inclusion criteria and 136 were matched by propensity scores. The overall functional outcome at 3 months was comparable between the two groups (EVT vs IVT as reference category: OR = 1.42 for higher mRS, 95% CI = 0.78–2.57, p = 0.254). The proportion of patients independent at 3 months was 63.2% in EVT and 72.1% in IVT (OR = 0.67, 95% CI = 0.32–1.37, p = 0.272). Symptomatic intracranial hemorrhages were overall rare and present only in the IVT group (IVT = 5.9% vs EVT = 0%). Mortality at 3 months was also similar between the two groups (IVT = 0% vs EVT = 1.5%). Conclusion: In this multicenter nested analysis, EVT and IVT in patients with acute ischemic stroke due to IPCAO were associated with similar overall good functional outcome and safety. Randomized studies are warranted.

https://journals.sagepub.com/doi/pdf/10.1177/23969873221150125

Endovascular therapy outcome in isolated posterior cerebral artery occlusion strokes: A multicenter analysis of the Swiss Stroke Registry

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

Neurologie

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Transient global amnesia with unexpected clinical and radiological findings: A case series and systematic review

Endovascular therapy outcome in isolated posterior cerebral artery occlusion strokes: A multicenter analysis of the Swiss Stroke Registry

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

Neurologie