Risk factors predicting recurrence of transient global amnesia
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ORIGINAL ARTICLE
Risk factors predicting recurrence of transient global amnesia Renato Oliveira 1,2,3
&
Tomás Teodoro 3,4 & Inês Brás Marques 1,2
Received: 14 July 2020 / Accepted: 30 September 2020 # Fondazione Società Italiana di Neurologia 2020
Abstract Objective To assess risk factors of transient global amnesia (TGA) recurrence. Methods Retrospective study of a case series of patients with the diagnosis of TGA in our neurology center in the last 8 years, identified through an anonymized database search. TGA was identified by applying Hodges and Warlow criteria. Results Seventy patients (70% female, average age 64.8 ± 7.8 years) were enrolled; mean follow-up was 16.5 months. More frequent co-morbidities were hypertension (50%), depression (25.7%), diabetes mellitus (17.1%), migraine (15.7%), and cerebrovascular disease (8.6%). Average TGA episode duration was 4 h. Forty-one percent had an identifiable trigger—emotional stress (25.7%), physical effort (8.6%), and sexual intercourse (4.3%). Five patients (7.1%) had hippocampus restriction on diffusion weighted MRI. Nineteen patients (27.1%) had TGA recurrence. Patients with recurrent TGA were more likely to be female and have history of depression, shorter duration episode, and hippocampus hyperintensity on brain MRI. None of the other clinical characteristics and complementary studies were predictors of recurrence. In the multivariate analysis, history of depression was the only factor found to predict which patients had a higher risk of recurrence. Conclusion We present a cohort of TGA patients with a considerable recurrent rate (27%), alerting for the possibility of recurrence of this clinical entity. TGA recurrence was associated with the following factors: female sex, depression, shorter episode duration, and hippocampal hyperintensity on brain MRI. History of depression was found to be the most important recurrence predictor in our study. Keywords Memory . Transient global amnesia . Cognition . Amnesia
Introduction Transient global amnesia (TGA) is a syndrome described in the 1950s, characterized by sudden anterograde and, sometimes, retrograde amnesia of less than 24 h in duration, accompanied by repetitive questioning, in the absence of other neurological symptoms [1–3]. TGA most commonly presents in the seventh decade of life with a slight female predominance [4]. The diagnosis is clinical, based on Hodges and
* Renato Oliveira [email protected] 1
Department of Neurology, Hospital da Luz Lisboa, Avenida Lusíada 100, 1500-650 Lisbon, Portugal
2
Headache Center, Hospital da Luz Lisboa, Lisbon, Portugal
3
Comprehensive Health Research Centre, Universidade Nova de Lisboa, Lisbon, Portugal
4
Department of Psychiatry, Centro Hospitalar Psiquiátrico de Lisboa, Lisbon, Portugal
Warlow criteria [3]. The risk factor most strongly associated with TGA is migraine [4]. MRI studies have been crucial in the characterization of this entity, showing typical focal hyperintensity in the hippocampus on DWI, most frequent detected 24–72 h
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