Hippocampal infarction: redefining transient global amnesia

Neurol Sci. 2022 Jul;43(7):4281-4286. doi: 10.1007/s10072-022-05980-6. Epub 2022 Mar 4.

Abstract

Background and aims: Transient global amnesia (TGA) is a clinical syndrome characterized by sudden anterograde amnesia not accompanied by other neurological symptoms. There is no consensus on the underlying pathophysiological mechanism. However, diffusion-weighted imaging (DWI) of the magnetic resonance imaging (MRI) has demonstrated hippocampal lesions in as many as 50% of cases. This paper describes a series of patients with TGA and hippocampal lesions.

Methods: This study assessed vascular risk factors in patients older than age 18 admitted to the Hospital Universitario San Ignacio, Bogota, Colombia, from May 2017 to June 2020 with a diagnosis of TGA and evidence of hippocampal ischemic lesion on 3 Tesla brain MRI.

Results: The authors identified 36 patients, 72.2% female, with mean age 62 years. Cardiovascular risk factors, most frequently high blood pressure, carotid disease, and dyslipidemia, were present in 75% of these patients. Hippocampal lesions were unilateral in 80% of cases, with median size 2.5 mm, most frequently located at the hippocampal body. Approximately 14% of patients also presented acute ischemic lesions in locations other than the hippocampus.

Conclusions: TGA is a clinical entity previously considered to have undetermined etiology. The present study used brain MRI to identify a group of patients with hippocampal ischemic lesions, finding associated vascular risk factors in a high proportion of them.

Keywords: Amnesia; Diffusion-weighted images; Hippocampal stroke; Hippocampus; Ischemic stroke; Transient global amnesia.

MeSH terms

  • Adolescent
  • Amnesia / complications
  • Amnesia, Transient Global* / diagnostic imaging
  • Amnesia, Transient Global* / etiology
  • Diffusion Magnetic Resonance Imaging / methods
  • Female
  • Hippocampus / pathology
  • Humans
  • Infarction / complications
  • Magnetic Resonance Imaging / adverse effects
  • Male
  • Middle Aged