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Interaction between the heart and the brain in transient global amnesia

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Abstract

Background

To analyse whether patients with transient global amnesia (TGA) have concomitant cardiac injury by assessing clinical symptoms, as well as blood and cardiologic test results.

Methods

In this retrospective observational study, we analysed 202 consecutive patients presenting with isolated TGA and treated at our institution between March 2010 and December 2018. We examined the incidence of high-sensitivity cardiac troponin I (hs-cTNI) level elevation, electrocardiogram (ECG) findings, and data on clinical management.

Results

Among the TGA patients, 17 (8.4%) exhibited elevated levels of hs-cTNI. Although none of the patients had ST elevation, 12 (6.7%) showed QTc prolongation and 11 (6.1%) an inverted T wave on ECG. No typical clinical symptoms suggestive of myocardial infarction were present in any of the cases, however, 17 (8.4%) patients complained of mild somatic symptoms. Patients with hs-cTNI level elevation had a significantly greater likelihood of a history of coronary heart disease (p = 0.03) and a significantly shorter TGA duration at presentation (p < 0.01). Of the 17 patients with hs-cTNI elevation, Takotsubo syndrome was diagnosed in 2, while in the remaining 15 hs-cTNI level elevation remained unresolved. A literature review indicated the female predominance for the occurrence of cardiac involvement in TGA.

Conclusions

Although the in-hospital outcomes appear favourable in all cases reported thus far, we believe that all patients with TGA should be carefully evaluated for potential underlying cardiac involvement and comorbidity. Further research on cardiac vulnerability in TGA should attempt to develop a diagnostic algorithm and assess the potential causes of cardiac injury in TGA.

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Author notes

  1. Philipp Eisele and Stefan Baumann have contributed equally to the manuscript.

Authors and Affiliations

  1. Department of Neurology, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68135, Mannheim, Germany

    Philipp Eisele, Laila Noor, Anne Ebert, Achim Gass, Michael Platten & Kristina Szabo

  2. First Department of Medicine - Cardiology, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany

    Stefan Baumann, Ibrahim El-Battrawy & Ibrahim Akin

  3. DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg-Mannheim, Mannheim, Germany

    Stefan Baumann, Ibrahim El-Battrawy & Ibrahim Akin

  4. Institute for Clinical Chemistry, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany

    Maximilian Kittel

Authors
  1. Philipp Eisele
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  2. Stefan Baumann
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  3. Laila Noor
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  4. Ibrahim El-Battrawy
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  8. Maximilian Kittel
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Contributions

All the authors contributed to the study conception and design, material preparation, data collection and analysis. Kristina Szabo wrote the first draft of the manuscript and all the authors commented on previous versions of the manuscript. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Kristina Szabo.

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On behalf of all the authors, the corresponding author states that there is no conflict of interest.

Ethical standard

The study was approved by the Ethics Committee of the Medical Faculty Mannheim, Heidelberg University and conformed to the Code of Ethics of the World Medical Association (Declaration of Helsinki, 6th revision, 2008).

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Eisele, P., Baumann, S., Noor, L. et al. Interaction between the heart and the brain in transient global amnesia. J Neurol 266, 3048–3057 (2019). https://doi.org/10.1007/s00415-019-09529-0

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  • DOI: https://doi.org/10.1007/s00415-019-09529-0

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