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NEUROLOGY 2008;70:1030-1035
© 2008 American Academy of Neurology

Focal MR spectroscopy of hippocampal CA-1 lesions in transient global amnesia

T. Bartsch, MD, K. Alfke, MD, S. Wolff, PhD, A. Rohr, MD, O. Jansen, MD and G. Deuschl, MD

From the Department of Neurology (T.B., G.D.) and Section of Neuroradiology (K.A., S.W., A.R., O.J.), University Hospital Schleswig-Holstein, Kiel, Germany.

Address correspondence and reprint requests to Dr. T. Bartsch, Dept. of Neurology, University Hospital Schleswig-Holstein, Kiel, Schittenhelmstr. 10, 24105 Kiel, Germany t.bartsch{at}neurologie.uni-kiel.de

Objective: The pathomechanisms of transient global amnesia (TGA) remain enigmatic. Focal MR signal diffusion changes in the CA-1 sector of the hippocampus have been described in transient global amnesia, but the pathophysiologic correlate of these lesions is unknown.

Methods: We studied the metabolic spectra of diffusion lesions in the CA-1 sector hippocampus of seven patients with TGA using MR spectroscopy (MRS) between 24 and 72 hours after onset and 2 to 5 months later. The amnestic deficit was studied using a neuropsychometric test battery.

Results: Four out of seven patients with an acute TGA showed a diffusion lesion with a corresponding T2 lesion in the CA-1 sector of the hippocampus. Selective hippocampal MRS of diffusion lesions showed a lactate peak in three of four patients, but not in patients without a diffusion lesion. The NAA/creatine ratio was normal.

Conclusion: Lactate as a marker of anaerobic glycolysis indicates acute metabolic stress of CA-1 neurons in TGA whereas long-term neuronal metabolic changes are not found. This implies that the acute effect on hippocampal CA-1 neurons is the functional correlate of a transient global amnesia reflecting a transient perturbation of memory relevant circuits in the hippocampus.

Abbreviations: ACE = ACE inhibitor; ADC = apparent diffusion coefficient; artHT = arterial hypertension; asp = aspirin; CA = cornu ammonis; CHD = coronary heart disease; DWI = diffusion-weighted imaging; FOV = field of view; hypchol = hypercholesterolemia; MI = myocardial infarction; MRS = MR spectroscopy; RAVLT = Rey Auditory Verbal Learning and Recognition test; RFc = Rey-Osterrieth Complex Figure copy; RFr = Rey-Osterrieth delayed recall; TE = echo time; TGA = transient global amnesia; TI = inversion time; TR = repetition time; TSE = turbo spin echo.

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Disclosure: The authors report no conflicts of interest.

Received August 19, 2007. Accepted in final form November 21, 2007.

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