To cite this article: Ozkul-Wermester O, et al. Transient global amnesia revealing multiple sclerosis. Presse Med. (2015), http://dx. Presse Med. 2016; //: ///

Transient global amnesia revealing multiple sclerosis Ictus amnésique révélant une sclérose en plaques We report the case of a 51-year-old man who presented with typical symptoms of transient global amnesia (TGA) consisting in repetitive questions with anxiety over the last hours. Medical past history consisted only in an anxious personality disorder. Patient complained of left sided paresthesia since waking-up without sensitive deficit at examination. Cognitive functions other than memory loss were normal. The neurological examination was unremarkable. He recovered his memory after 6 hours. The patient did not remember anything about what happened during the episode. Left paresthesia disappeared within two weeks. A CT scan of the brain performed on the first day was normal. Blood tests were normal. Magnetic resonance (MR) brain imaging performed 48 h after TGA showed symmetrical, punctuate, restricted diffusion in both hippocampi. These bilateral hippocampi lesions on restricted diffusion were not seen on any other sequences figure 1. FLAIR sequence showed four periventricular and four juxtacortical white matter lesions suggesting demyelination but gadolinium injection was not performed. Neuropsychological evaluation including MMSE, the Grober-Buschke Test, Rey Complex Figure Test, Wisconsin Card Sorting Test, Stroop Test, and Trail Making Test revealed only moderate attention deficit. Control brain MRI was performed one month later showing white matter abnormalities fulfilling McDonald criteria for multiple sclerosis with a new gadolinium-enhanced lesion. MR

imaging of spinal cord was normal. Cerebrospinal fluid (CSF) analysis revealed 11 leukocytes/mm3, elevated proteins (70 mg/dL) and presence of three oligoclonal bands. He was diagnosed with transient global amnesia concomitant to a first relapse of relapsing-remitting multiple sclerosis characterized by his left paresthesia and a treatment by dimethylfumarate was started. Recent case reports show that cognitive and neuropsychiatric symptoms can be the presenting features of multiple sclerosis [1] but as our knowledge typical TGA with associated characteristic hippocampal lesion in diffusion-weighted imaging has not yet been reported. TGA is still an enigmatic disease. Involvement of temporomesial structures such as the hippocampus has been suggested by several authors. These structures are involved in the memory processing, stress and emotion. Precipitating events encompassing physical or emotional factors can be observed. Like our patient who had anxiety, a higher prevalence of psychiatric conditions was found in patients with TGA [2,3]. On MRI, transient lesions are confined to the CA1 field of the hippocampal cornu ammonis which is particularly involved in memory and vulnerable to metabolic changes associated with a stress response [4,5]. Recent literature shows that increased lactate, calcium, glutamate, and other molecules could cause a metabolic stress on the hippocampal region [3,4]. Those cases of simultaneous lesions in both hippocampi support the metabolic hypothesis. In our case, we can hypothesis that the stress induced by symptoms such as left paresthesia, or that an acute inflammatory lesion could have precipitated a TGA and that this association could be fortuitous. We should bear in mind that TGA can be associated with symptoms of multiple sclerosis. Physicians should pay attention and execute brain imaging when TGA is associated with other neurological symptoms.


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Letter to the editor

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To cite this article: Ozkul-Wermester O, et al. Transient global amnesia revealing multiple sclerosis. Presse Med. (2015), http://dx.

Letter to the editor

O. Ozkul-Wermester, R. Lefaucheur, V. Macaigne, E. Guegan-Massardier, B. Bourre

Figure 1


Axial diffusion-weighted images (b = 1000 s/mm2) showing transient global amnesia characteristic hippocampal hyperintensities (A, B, arrows). FLAIR sequence showing periventricular white matter abnormalities suggestive of demyelination (C, D). Control MRI showing new periventricular gadolinium-enhanced T1 and FLAIR lesion (E, F) (arrow heads)

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To cite this article: Ozkul-Wermester O, et al. Transient global amnesia revealing multiple sclerosis. Presse Med. (2015), http://dx.


Webb AJS, Rothwell PM. Transient global amnesia associated with bilateral restricted diffusion in the lateral hippocampus. J Neurol Neurosurg Psychiatry 2013;84:522.

Disclosure of interest: the authors declare that they have no competing interest.

Ozlem Ozkul-Wermester1, Romain Lefaucheur1, Valérie Macaigne2, Evelyne Guegan-Massardier1, Bertrand Bourre1

References [1]




Assouad R, Louapre C, Tourbah A, Papeix C, Galanaud D, Lubetzki C, et al. Clinical and MRI characterization of MS patients with a pure and severe cognitive onset. Clin Neurol Neurosurg 2014;126C:55–63. Quinette P, Guillery-Girard B, Dayan J, de la Sayette V, Marquis S, Viader F, et al. What does transient global amnesia really mean? Review of the literature and thorough study of 142 cases. Brain 2006;129(Pt 7):1640–58. Döhring J, Schmuck A, Bartsch T. Stress-related factors in the emergence of transient global amnesia with hippocampal lesions. Front Behav Neurosci 2014;8:287. Scheel M, Malkowsky C, Klingebiel R, Schreiber S, Bohner G. Magnetic resonance imaging in transient global amnesia lessons learned from 198 cases. Clin Neuroradiol 2012;22:335–40.

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Department of Neurology, Rouen University Hospital, University of Rouen, 76031 Rouen cedex, France 2 Department of Radiology, Rouen University Hospital, University of Rouen, 76031 Rouen cedex, France

Correspondence: Ozlem Ozkul-Wermester, Department of Neurology, Rouen University Hospital, University of Rouen, 1, rue de Germont, 76031 Rouen cedex, France [email protected] Received 24 August 2015 Accepted 15 September 2015 Available online: © 2015 Elsevier Masson SAS. All rights reserved.


Acknowledgements: the authors would like to thank Dr Aude TriquenotBagan for her contribution to the patient management.

Letter to the editor

Transient global amnesia revealing multiple sclerosis

Transient global amnesia revealing multiple sclerosis.

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