Guideline “Transient Global Amnesia (TGA)” of the German Society of Neurology (Deutsche Gesellschaft für Neurologie): S1-guideline

Abstract

Introduction In 2022 the DGN (Deutsche Gesellschaft für Neurologie) published an updated Transient Global Amnesia (TGA) guideline. TGA is characterized by a sudden onset of retrograde and anterograde amnesia for a period of one to a maximum of 24 h (with an average of 6 to 8 h). The incidence is estimated between 3 and 8 per 100,000 population/year. TGA is a disorder that occurs predominantly between 50 and 70 years. Recommendations The diagnosis of TGA should be made clinically. In case of an atypical clinical presentation or suspicion of a possible differential diagnosis, further diagnostics should be performed immediately. The detection of typical unilateral or bilateral punctate DWI/T2 lesions in the hippocampus (especially the CA1 region) in a proportion of patients proves TGA. The sensitivity of MRI is considered higher when performed between 24 and 72 h after onset. If additional DWI changes occur outside the hippocampus, a vascular etiology should be considered, and prompt sonographic and cardiac diagnostics should be performed EEG may help to differentiate TGA from rare amnestic epileptic attacks, especially in recurrent amnestic attacks. TGA in patients < 50 years of age is a rarity, therefore it is mandatory to rapidly search for other causes in particular in younger patients. The cause of TGA is still unknown. Numerous findings in recent years point to a multifactorial genesis. Because the pathomechanism of TGA is not yet clearly known, no evidence-based therapeutic or prophylactic recommendations can be made. Conclusions There is no evidence for chronic sequelae of TGA with respect to cerebral ischemia, chronic memory impairment, or the onset of dementia-related syndromes.

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“…Instead, the patient presented with a TGA. The amnesia attack fulfilled both Caplan’s and Hodges and Warlow's criteria for TGA [ 4 - 7 ]. The episode was witnessed; it involved anterograde amnesia lasting for only a few hours, without any other focal neurological sign or epileptic feature, in the absence of head trauma or loss of personal identity [ 4 ].…”

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“…Although there is not much information regarding the etiology of TGA, it is known that it is more common between the fifth and seventh decades of life, and is usually associated with a trigger, like extenuating physical activity, cold water immersion, receiving bad news, sexual intercourse, or situations associated high levels of stress [ 1 , 2 , 4 ]. There are several theories that propose vascular phenomena, migraine, or epilepsy in the genesis of TGA but they are yet to be proven [ 1 ].…”

“…The diagnosis of TGA can only be made in the absence of head trauma or seizures in the 24 hours previous to the ensuing symptoms [2]. The estimated incidence of TGA is between 3-8/100,000 population per year, and its etiology and risk factors are not entirely known [1][2][3][4].…”

“…TGA differential diagnosis is extensive and includes other transient memory disturbs, epileptiform or concussional transient amnesia, and several other intracranial injuries (e.g., astrocytomas) or aura from migraines [ 2 ]. The prognosis is usually very good with complete recovery after 24 hours in most cases [ 3 , 4 ].…”

Correction: Guideline “Transient Global Amnesia (TGA)” of the German Society of Neurology (Deutsche Gesellschaft für Neurologie): S1-guideline

“…Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Following publication of the original article [1], the authors reported that the author name "Nils Nellessen" was incorrectly written as "Nils Nellesen".…”