Transient Global Amnesia and Jugular Vein Incompetence
To the Editor:
In the January issue of Stroke, Cejas et al1 documented the frequency of jugular vein incompetence in patients with transient global amnesia, and Altamura and Vernier2 editorialized on the subject. Neither communication wrestles with the major dilemma in assigning a causal relationship to the venous phenomenon, namely “How can a very transient change in venous drainage from the cranium account for a disorder that invariably lasts hours?” Increased venous pressure, even when sustained as in patients with congestive heart failure and pericardial effusions, has not been recognized as causing transient global amnesia.
In previous communications3–6 I have shared my impression that transient global amnesia is most often caused by arterial vasoconstriction often precipitated by systemic changes—Valsalva maneuvers, emotional stress, heavy work, immersion in cold water, etc. Could the transient but often sudden change in venous flow trigger arterial vasoconstriction in susceptible individuals. Hypercholesterolemia and other atherosclerotic risk factors and aging make arteries more susceptible to vasoconstriction. Migraine, a disorder known to contain vasoconstriction, is an important cause of transient global amnesia.
Cejas C, Cisneros LF, Lagos R, Zuk C, Ameriso S. Internal jugular vein valve incompetence is highly prevalent in transient global amnesia. Stroke. 2010; 41: 67–71.
Altamura C, Vernieri F. Internal jugular vein incompetence in transient global amnesia. Stroke. 2010; 41: 1–2.
Caplan L. Transient global amnesia. In: Vinken P, Bruyn G, Frederick J eds. Handbook of Clinical Neurology. vol. 1 (46). Amsterdam: Elsevier Publishing Co.; 1985: 205–218.
Caplan LR. Transient global amnesia: criteria and classification. Neurology. 1986; 36: 441.
Caplan LR. TGA Criteria: what’s in a name? Neurology. 1986; 36: 1625–1626.
Caplan LR. Transient global amnesia: characteristic features and overview. In: Markowitsch HJ, ed. Transient Global Amnesia and Related Disorders. Toronto: Hogrefe and Huber Publ; 1990: 15–27.