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(Stroke. 2008;39:2219.)
© 2008 American Heart Association, Inc.

Original Contributions

Transient Global Amnesia

Diffusion-Weighted Imaging Lesions and Cerebrovascular Disease

Christian Enzinger, MD; Felix Thimary, MD; Peter Kapeller, MD; Stefan Ropele, PhD; Reinhold Schmidt, MD; Franz Ebner, MD Franz Fazekas, MD

From the Department of Neurology (C.E., S.R., R.S., F.F.) and the Section of Neuroradiology (C.E., F.T., F.E.), Department of Radiology, Medical University of Graz, Graz; and the Department of Neurology (P.K.), Villach, Austria.

Correspondence to Christian Enzinger, MD, Department of Neurology and Section of Neuroradiology, Medical University of Graz, Auenbruggerplatz 22, A-8036 Graz, Austria. E-mail chris.enzinger{at}meduni-graz.at

Background and Purpose— A hypoxic-ischemic origin of transient global amnesia (TGA) has been suggested on the basis of the observation of infarctlike diffusion-weighted imaging (DWI) abnormalities in some affected individuals. We tested this hypothesis by comparing vascular risk factors, magnetic resonance imaging (MRI) markers of cerebral small-vessel disease, and other evidence of a cerebrovascular disorder between TGA patients with (DWI+) and without (DWI–) DWI lesions and normal community-based controls.

Methods— We retrospectively identified 86 patients hospitalized for TGA (mean±SD age, 65.9±10.9 years; 62% female). Brain MRI at 1.5 T was assessed for DWI lesions exhibiting restricted diffusion (ie, DWI+), white-matter hyperintensities, lacunes, and chronic infarcts (median time lag to clinical onset, 66.6±54.6 hours). Vascular risk factors and findings from duplex sonography, ECG, and echocardiography were recorded. A 1:2 age- and sex-matched sample of 172 elderly subjects (mean±SD age, 65.6±9.3 years; 62% female) free of neuropsychiatric disease served for comparison.

Results— DWI lesions were observed in 10 patients with TGA (11.5%; mean±SD age, 68.3±5.4 years; 8 women). They were all small and located in the mesiotemporal region (9 left hemisphere, 5 right hemisphere). The vascular risk profile of TGA patients and concomitant changes on brain MRI were comparable with those of healthy controls and did not show significant differences between DWI+ and DWI– subjects. A comprehensive diagnostic workup also provided no evidence for a higher rate of cerebrovascular disorder-related abnormalities in either the total group of TGA patients or TGA DWI+ patients.

Conclusions— These findings do not support a cerebrovascular etiology of TGA, even in those individuals showing acute DWI lesions. Other pathophysiologic mechanisms need to be explored.

Key Words: transient global amnesia • amnestic syndrome • magnetic resonance imaging • diffusion-weighted imaging • risk factors