Stroke Centre and Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Neurology Unit, Department of Emergency, Santa Chiara Hospital, Trento, Italy.
Stroke Centre and Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
J Neurol Sci. 2022 Oct 15;441:120349. doi: 10.1016/j.jns.2022.120349. Epub 2022 Jul 23.
Transient global amnesia (TGA) represents a benign neurological syndrome of unknown pathophysiology, often accompanied by vanishing hippocampal punctate diffusion-weighted imaging lesions (HPDL). The literature suggests that TGA may present with unusual features. This study analyses atypical clinical and radiological manifestations of patients with TGA and/or HPDL.
We retrospectively reviewed patients with atypical clinical or radiological presentations of TGA and/or HPDL in three neurology centers. We also performed a systematic review of literature using predefined search terms. Results were classified as: A) Atypical clinical manifestations of TGA (such as amnesia with additional manifestations, or only non-amnesic manifestations); B) Atypical radiological manifestations of clinically typical TGA.
We identified 83 patients: 18 in our centres (median age 63.5 years, 39% female) and 65 in the literature. In group A, 43 patients presented atypical clinical manifestations such as TGA with added transitory cognitive or sensory-motor deficits, seizures, headaches, but also non-amnesic presentations associated with HPDL and incidental HPDL without symptoms. In group B, 40 patients with typical clinical TGA showed extra-hippocampal punctate diffusion lesions (E-HPDL) which disappeared on follow-up imaging. Using clinical and radiological manifestations, we classified these patients into different categories describing a "TGA-PDL spectrum".
TGA may have atypical clinical manifestations despite typical neuroimaging and patients with typical TGA may show vanishing extra-hippocampal punctate diffusion lesions. TGA, related clinical manifestations, and vanishing punctate diffusion lesions should be considered part of a larger "TGA-PDL spectrum", allowing for better diagnosis of typical and atypical cases and stimulating further studies.
短暂性全面遗忘症（TGA）代表一种病因不明的良性神经综合征，常伴有海马点状弥散加权成像病灶（HPDL）消失。文献表明，TGA 可能表现出不典型的特征。本研究分析了 TGA 和/或 HPDL 患者不典型的临床和影像学表现。
我们回顾性分析了三个神经病学中心 TGA 和/或 HPDL 表现不典型的患者。我们还使用预设的搜索词对文献进行了系统回顾。结果分为：A）TGA 不典型临床表现（如伴有其他表现的遗忘症，或仅有非遗忘症表现）；B）临床典型 TGA 的不典型影像学表现。
我们共纳入 83 名患者：18 名来自我们的中心（中位年龄 63.5 岁，39%为女性），65 名来自文献。在 A 组中，43 名患者表现出不典型的临床症状，如伴有短暂性认知或感觉运动障碍、癫痫、头痛等附加症状的 TGA，也有非遗忘症表现与 HPDL 相关，以及无症状的偶然 HPDL。在 B 组中，40 名有典型临床 TGA 的患者出现了海马外点状弥散病变（E-HPDL），这些病变在随访影像学上消失。根据临床和影像学表现，我们将这些患者分为不同的类别，描述了一个“TGA-PDL 谱”。
尽管神经影像学表现典型，但 TGA 仍可能出现不典型的临床表现，而典型 TGA 患者可能出现消失的海马外点状弥散病变。TGA、相关临床表现和消失的点状弥散病变应被视为更大的“TGA-PDL 谱”的一部分，有助于对典型和不典型病例进行更好的诊断，并激发进一步的研究。
