Stress-related factors in the emergence of transient global amnesia with hippocampal lesions

Abstract

The transient global amnesia (TGA) is a rare amnesic syndrome that is characterized by an acute onset episode of an anterograde and retrograde amnesia. Its origin is still debated, but there is evidence for psychological factors involved in TGA. In neuroimaging, selective lesions in the CA1 field of the hippocampus can be detected, a region that is particularly involved in the processing of memory, stress and emotion. The aim of this study was to assess the role of psychological stress in TGA by studying the prevalence of stress related precipitating events and individual stress-related personality profiles as well as coping strategies in patients. The hypothesis of a functional differentiation of the hippocampus in mnemonic and stress-related compartments was also evaluated. From all 113 patients, 18% (n = 24) patients experienced emotional and psychological stress episodes directly before the TGA. In a cohort of 21 acute patients, TGA patients tend to cope with stress less efficiently and less constructively than controls. Patients who experienced a stress related precipitant event exhibited a higher level of anxiety in comparison to non-stress patients and controls. However, there was no difference between the general experience of stress and the number of stress inducing life events. The majority of patients (73%) did show typical magnetic resonance imaging (MRI) lesions in the CA1 region of the hippocampal cornu ammonis. There was no clear association between stressful events, distribution of hippocampal CA1 lesions and behavioral patterns during the TGA. Disadvantageous coping strategies and an elevated anxiety level may increase the susceptibility to psychological stress which may facilitate the pathophysiological cascade in TGA. The findings suggest a role of emotional stress factors in the manifestation of TGA in a subgroup of patients. Stress may be one trigger involved in the emergence of transient lesions in the hippocampal CA1 region, which are thought to be the structural and functional correlate of TGA.

Medical Procedure-Related Transient Global Amnesia

“…Many cases of TGA have followed Valsalva-associated activities, such as nausea, vomiting, swimming, crying, taking a cold shower, coughing, emotional stress, exercise, and acute pain, supporting this hypothesis [1][2][3][4]. Recently, hypersensitivity of the hypothalamic-pituitary-adrenal axis to stress responses involving increased cortisol levels has been suggested as another possible mechanism [5,6].…”

“…The deleterious effects of stress and increased cortisol levels on the hippocampus have also been suggested as a possible mechanism of TGA [5,6]. Higher cortisol levels in response to stress have been observed in patients with TGA, as has hypersensitivity of the hypothalamic-pituitary-adrenal axis [6].…”

Transient global amnesia

“…Savitz and Caplan reported a case of transient global amnesia after sildenafil (Viagra) use (Savitz and Caplan 2002). About 50% of the patients report Valsalva-like activities preceding transient global amnesia (Sander et al 2000), and close to 20% experience emotional and psychological stress episodes directly before the transient global amnesia event (Döhring et al 2014). Transient global amnesia has also been reported to be associated with bilateral vertebral artery dissection (Michel et al 2004) and aortic dissection (Mondon et al 2007) and has been reported following the use of ergotamine and dihydroergotamine to treat migraine (Gil-Martinez and Galiano 2004).…”

Emotional stress-induced transient global amnesia with bilateral hippocampal ischemic lesion

“…J. Dohring и соавт. [10] утверждают, что пациенты с ТГА отличаются от здоровых лиц определенными аспектами копингового поведения. Они выделяют два существенных момента копинговых стратегий, присущих пациентам с ТГА: если здоровые испытуемые скорее склонны преуменьшать свои проблемы, сравнивая себя с другими людьми, то пациенты с ТГА чаще испытывают чувство вины.…”