Of the 153 patients reviewed between 19, 114 patients met the proposed criteria for pure TGA. Exclusionary criteria for pure TGA included focal neurological symptoms, such as ataxia, limb weakness, and sensory disturbances. They divided patients into the following three categories: pure TGA, probably epileptic amnesia, and probably TIA. Hodges and Warlow 15 later developed criteria for the clinical syndrome in 1990 ( Table 1), and since then, this has been used as the foundation of TGA diagnosis.
Fisher and Adams 13 coined the term TGA in 1958 however, it was not until 1964 that they detailed a report of 17 patients with sudden onset anterograde amnesia and confusion that resolved within a few hours. 11, 12 Subjects were described as becoming repetitious and asking the same questions, although mostly revolved around the memory loss itself. It was first described in 1956 as an “isolated episode of confusion with amnesia” not otherwise associated with other neurological deficits. Other than migraine headaches, there are no definitive risk factors for the development of TGA.
Chances of recurrence are reported variedly from 2.9 to 25%. A total of 54%–67% of TGA patients are female. Peak incidence is around the age of 62 years (standard deviation 10 years). In summary, according to community-based studies, the annual incidence of TGA is 5–10/100,000 and 23.5–32/100,000 for people aged 50 years and older. 6 Additionally, a significantly higher percentage of TGA subjects (33.3%) reported a family history of psychiatric disease as compared with TIA subjects (13.7%). TGA subjects had a significantly higher percentage of psychiatric disease compared to TIA controls (39.2% vs 13.7%, age- and sex-adjusted odds ratio =2.86). Psychiatric disease was defined as having “a diagnosis of depression or anxiety disorder” or having received “treatment with specific drugs for at least 3 months”. One study compared psychiatric disease in 51 subjects who experienced a TGA to 51 subjects who experienced a TIA. 9 Also, of note is that cancer diagnosis carries no increased risk of TGA, according to a prospective cohort study with 5,365,608 subjects running between 20. 8 Furthermore, a retrospective study of 85 TGA subjects revealed that those with history of two episodes of TGA showed a higher frequency of carotid atheromasia and ischemic heart disease than those with a history of just one episode of TGA. Within this same study, 632 transient ischemic attack (TIA) subjects had greater rates of hypertension, diabetes mellitus, ischemic stroke, and atrial fibrillation when compared with TGA subjects, likely indicating differing risk factors between TGA and TIA. A retrospective case–control study found age- and sex-matched control subjects (n=293) to have significantly decreased odds of having hyperlipidemia and ischemic heart disease when compared with those subjects with TGA (n=293). 7Ĭardiovascular risk factors are also well studied in TGA. No associations were found between various migraine subtypes and TGA. 7 Additionally, of the subjects who developed TGA after the age of 40 years, those with a history of migraine had a significantly younger age of onset (56.6) compared to the control group (61.4). In a 2014 population-based study (n=316,602), migraine patients were significantly more likely to develop TGA than their matched controls, with the incidence rate ratio of 2.48. A migraine history is one of the more notable risk factors associated with developing TGA.
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