Jugular Veins in Transient Global Amnesia

Abstract

Background and Purpose-Transient global amnesia (TGA) has been associated with an increased prevalence of internal jugular valve insufficiency and many patients report Valsalva-associated maneuvers before TGA onset. These findings have led to the assumption of hemodynamic alterations in intracranial veins inducing focal hippocampal ischemia. We investigated this hypothesis in patients with TGA and control subjects. Methods-Seventy-five patients with TGA and 75 age-and sex-matched healthy subjects were enrolled into a cross-sectional study. Extracranial and transcranial high-resolution venous echo-color-Doppler sonography was performed blindly in all patients and control subjects. Blood flow direction and velocities were recorded at the internal jugular veins, basal veins of Rosenthal, and vein of Galen, both at rest and during Valsalva-associated maneuvers. Results-Mean

Different Risk Factor Profiles between Transient Global Amnesia and Transient Ischemic Attack: A Large Case-Control Study

“…Among them, cerebral ischemia in terms of thromboembolic etiology or hemodynamics was investigated through several case-control studies in comparison with transient ischemic attack (TIA), but did not find an association between TGA and cardiovascular risk factors [6,7,8,9,10,11]. Those studies focused on arterial ischemia considering an abrupt onset of TGA or an MRI finding, but recent studies are in search of venous congestion with subsequent ischemia combined with jugular valve insufficiency [4,12,13,14,15,16]. However, the question still remains whether cardiovascular risk factors are related to the occurrence of TGA at all.…”

Transient Global Amnesia, Cerebral Veins, and the Need to Find the ‘Smoking Gun’

“…In this issue of Stroke, 1 Baracchini et al, in a very well-executed investigation, confirm a strong association between TGA and internal jugular valve insufficiency. The authors also explored, using ultrasonography, various cerebral veins at rest and during Valsalva maneuver in subjects with TGA and control subjects.…”

“…2,3 Internal jugular valve insufficiency appears to be the most prevalent abnormal finding in these patients. 1,4 Interestingly, another common finding in TGA is the presence of transient hyperintense lesions in the hippocampus on MRI using diffusion-weighted sequences. 5 Apparent diffusion coefficient reversal without persistent symptoms or T2 changes is uncommon.…”

Letter by Griebe et al Regarding Article, “Jugular Veins in Transient Global Amnesia: Innocent Bystanders”

“…The recent publication of Baracchini et al entitled "Jugular Veins in Transient Global Amnesia" 1 in Stroke reports extra-and transcranial high-resolution venous echo-color Doppler sonography findings in patients who have had an episode of transient global amnesia (TGA). The main finding of the authors is the absence of any intracranial venous hemodynamic alteration in these patients as compared with control subjects.…”