Factors Associated With Risk of Recurrent Transient Global Amnesia

Abstract

Importance: Transient global amnesia (TGA) is usually considered a benign event with a low recurrence rate. However, recurrence rates vary considerably among studies and there are no known risk factors for TGA.

Objective: To examine risk factors for the recurrence of TGA.

Design, setting, and participants: This retrospective cohort study involved medical record review of patients with isolated or recurrent TGA presenting to the Mayo Clinic in Rochester, Minnesota, between August 1, 1992, and February 28, 2018. A total of 1491 cases were reviewed and 1044 met diagnostic inclusion criteria for TGA, with the remainder excluded owing to indeterminate or alternate diagnoses or limited information available in the medical record.

Exposures: Single vs recurrent episodes of TGA.

Main outcomes and measures: Demographics, precipitating factors, migraine history, imaging and electrodiagnostic findings, and family history of TGA were collected. The main outcome measure was TGA recurrence.

Results: Of 1044 included patients, 575 (55.1%) were male, and the mean (SD) age at inclusion was 75.0 (11.5) years. A total of 901 patients (86.3%) had a single episode of TGA and 143 (13.7%) had recurrent episodes of TGA. The 2 groups were similar in age at inclusion, sex, identifiable triggers, and duration of anterograde amnesia. The number of recurrences ranged from 1 to 9, with 137 individuals (95.8%) having 3 or fewer recurrences. The mean (SD) age at first episode of TGA was 65.2 (10.0) years for individuals with a single episode vs 58.8 (10.3) years for those with recurrent episodes (P < .001). There was a personal history of migraine in 180 individuals (20.0%) with a single episode of TGA and 52 individuals (36.4%) with recurrent episodes of TGA (P < .001), and a family history of migraine in 167 individuals (18.5%) with a single episode of TGA and 44 individuals (30.8%) with recurrent episodes of TGA (P = .001). There were no electroencephalographic findings associated with increased risk of TGA recurrence. Acute and subacute temporal lobe abnormalities on results of magnetic resonance imaging were seen rarely and did not require intervention. A family history of TGA was identified in 12 individuals (1.3%) with a single episode of TGA and 4 individuals (2.8%) with recurrent episodes of TGA.

Conclusions and relevance: This study suggests that, in this large cohort of patients with TGA, recurrent TGA was associated with earlier age at the time of first TGA episode and higher prevalence of both personal and family history of migraine compared with isolated cases. These results can be used to counsel patients about risks of recurrence and may have implications for the understanding of TGA pathophysiology.

Figure 1.. Patient Selection Flowchart

TGA indicates transient global amnesia; and TIA, transient ischemic attack.

Figure 2.. Electrodiagnostic and Imaging Findings in Patients With Recurrent Transient Global Ischemia (TGA)

A, Electroencephalogram (EEG) bipolar montage depicting focal left temporal slowing (black boxes), which was the most common EEG finding in individuals with single and recurrent TGA episodes. B, Diffusion-weighted (left) and apparent diffusion coefficient (right) magnetic resonance imaging (MRI) results showing a recurrent TGA episode with the classic finding of focal mesial hippocampal diffusion restriction (white arrowheads). C, T1-weighted postgadolinium MRI showing a large left temporal developmental venous anomaly (white arrowhead).