Anterior portion of the cingulate gyrus: Transient global amnesia TGA is characterized by abrupt transient loss of anterograde memory, lasting up to 24 hours, and other focal neurological signs.
We report the case of a right-handed year-old female patient who presented temporal-spatial disorientation 5 minutes after ingestion of ml of iodinated contrast. The patient had mild temporal-spatial disorientation, with significant deficit in anterograde memory. After 12 hours under Que es transitoria yahoo dating, the patient progressed to gradual improvement and was discharged. A reevaluation after 15 days showed normal cortical functions, score on mini-mental state exam of 30, and unaffected working and recall memory.
No previous reports in the literature have described the location affected in this patient, rendering it a novel site consistent with this diagnosis.
A hyperintense signal is typically found, mainly in the hippocampus, but structures such as the amygdala, lenticular nucleus and neocortex were also reported in a study by Nakada et al. The case described below presents a typical picture of TGA, but with atypical location on the diffusion MRI in the anterior portion of the cingulate gyrus. To date, there are no reports of the involvement of this structure in investigations of TGA cases by imaging.
According to the attendant, the patient had 2 episodes of vomiting in small quantities, and then was taken to the emergency room. At first, her blood pressure was x 90, glucose 96, with no significant findings on physical examination. On neurological examination, about 1 hour after the onset of symptoms, the patient "Que es transitoria yahoo dating" alert, remained with mild temporal-spatial disorientation, not identifying the day of the month or week, with significant deficit in anterograde memory for both working and evocation domains.
Her memory was tested using the items of the mini-mental state exam immediate recall, interference followed by evocation and also by a non-verbal task - 3 objects were shown to the patient and hidden, an interference task was performed and then evocation of the objects placed was tested. The patient's retrograde memory was normal, showing correct recall of data preceding the episode.
Praxis, language, and sensitivity were all normal. At the time of the evaluation, the patient's behaviour was completely normal, and insight concerning the deficit was evident. No other focal deficits were detected. An initial CT scan was obtained and showed no
Que es transitoria yahoo dating abnormalities. An extended EEG revealed no epileptiform activity. A complete lab workup was performed, on which all blood counts, electrolytes, cardiac enzymes, hepatic enzymes, urine analysis tested normal.
How to cite this article. The hypothesis of irreversible dementia was excluded due to acute onset. After "Que es transitoria yahoo dating" under observation in the emergency room, she showed gradual improvement of the symptoms and was discharged Que es transitoria yahoo dating 12 hours after the start of the symptoms.
A reevaluation of the patient 15 days after the event showed intact cortical functions, with mini-mental state exam score of 30, and unaffected working memory and recall. A new MRI was performed and showed no abnormalities in the anterior portion of the corpus callosum.
Lewis 6 proposed in that situations increasing blood reflux, such as the Valsalva maneuver, those of vasoconstrictors and peripheral immersion in ice water, could generate a venous congestion in the region of the hippocampus followed by subsequent ischemia.
InAkkawi et al. Our patient most probably had some degree transient increase in intracranial pressure due to a Valsalva maneuver secondary to the vomiting episodes and therefore abnormalities in the venous flux can also be considered. There is worldwide discussion about the connection of migraine with aura and TGA. Authors explain that there are decreased levels of glutamate, promoting a depression of brain electrical activity that initially manifests with tissue hyperperfusion followed by hypoperfusion, causing the migraine.
This mechanism could possibly be the same as TGA and might explain some results showing that patients with a history of migraine are more likely to have an episode of TGA.
Another cause "Que es transitoria yahoo dating" TGA is the use of contrast for imaging. There is one case report that documented a probable TGA during a Valsalva maneuver after administration of saline to perform a transesophageal echocardiogram in a patient with patent foramen ovale.
In the case in question, three hours after contrast administration, the patient developed disorientation in time and space, but without focal neurological signs. An explanation for this phenomenon is that toxicity of iodine causes platelet dysfunction which leads to a decrease in cerebral blood flow. However, there was no edema evidenced and the literature does not report any association of neurotoxicity with oral iodinated contrast, making this hypothesis less likely to explain our patient's clinical presentation.
Furthermore, patients with underlying brain conditions, impaired kidney function, those who have received a large contrast dose or prolonged exposure to contrast media are at the Que es transitoria yahoo dating risk for developing contrast neurotoxicity, where the patient reported met none of these conditions.
The fronto-polar artery, a branch from the anterior cerebral artery, is responsible for the irrigation of the area altered in the first MRI of this patient. Regarding the location, the anterior cingulate gyrus is to a variety of behavior manifestations. Functional neuroimaging studies in humans show that it plays an important role in emotional memory content. The aetiology of transient global amnesia. A casecontrol study of cases with prospective follow-up.
What does transient global amnesia really mean? Review of the literature and thorough study of cases. Association of diffusion weighted imaging abnormalities and recurrence in transient global amnesia. J Clin Neurosci ; Bartsch T, Deuschl G. High-field, T2 reversed MRI of the hippocampus in transient global amnesia. A etiology of transient global amnesia. Transient global amnesia and disturbance of venous flow patterns. Transient global amnesia during transoesophageal echocardiogram.
Transient global amnesia following coronary angiography. J Postgrad Med ; Contrast-induced encephalopathy following coronary angioplasty with iohexol. Southern Med J ; New insights into the risk factors of contrast-induced encephalopathy. J Endov Ther ; Neurotoxicity of water-soluble contrast media. Cognitive and emotional influences in anterior cingulate cortex.
Trends Cogn Sci ;4: The prefrontal cortex and cognitive control. Nat Rev Neurosci ;1: New circuits for old memories: Diffusion Magnetic Resonance Imaging in transient global amnesia.
Selective affection of hippocampal CA-1 neurons in patients with transient global amnesia without long-term sequelae. Focal lesions of human hippocampal CA1 neurons in transient global amnesia impair place memory.
Bilateral hippocampal abnormalities on diffusion-weighted MRI in transient global amnesia: Acta Neurol Taiwan ; Acta Neurol Scand Medical Doctor at Northeast Medical Emergencies 2. Accepted in final form February 15, The authors report no conflicts of interest. Introducción: La displasia epifisaria de la cabeza femoral (DECF) es definida como antes, el cual fue diagnosticado en su momento como sinovitis transitoria.
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