短暂性完全遗忘综合征(附4例临床分析)

短暂性全脑遗忘是一种临床综合征 ,特点为突然不能接受新的信息 ,而保留远期记忆 ,保持自知力 ,常在 2 4小时内缓解。我科 1989年～ 1999年共收治了 4例 ,现报告如下。例 1,女 ,6 8岁 ,干部。 1989年 8月 6日上午散步后上街买菜 ,中午时发现上午 3个多小时的买菜经过全无记忆 ,不知道买了多少菜 ,花了多少钱 ,是否与菜主讨价 ,买菜后是否又做了其它事情。查体无阳性体征 ,心电、脑电、头颅 CT均正常 ,TCD示椎基底动脉紧张度增高。诊断 :短暂性完全遗忘综合征。予盐酸培它啶及胞二磷胆碱治疗 15天。 2个月随访正常 ,无再次发作。例 2 ,男 ,…     

成人自主神经性癫痫(附3例临床和脑电图分析)

<正> 成人自主神经性癫痫很少见,为提高对本病的认识,现将我们诊治过的、资料较完整的三例报告并分析如下。 例1王某,女,68岁,主因发作性腹痛15年,于2002年7月来我科就诊。患者于15年前始有发作性右上腹和中上腹部剧烈疼痛,疼痛剧烈难忍,疼痛性质     

短暂性全面性遗忘14例临床分析

目的 探讨短暂性全面性遗忘(TGA)的临床特点.方法 回顾性分析14例TGA患者的临床资料.结果 本组患者男女各为7例,年龄52～70岁;5例因情绪激动、4例因受凉、2例因劳累发病.临床表现为突然出现的顺行及逆行遗忘,持续时间0.5～15 h,6例伴有头痛或头晕;体检无阳性体征发现;头颅MRI示4例海马区DWI小灶高信号.结论 TGA临床特征为一过性记忆障碍,情绪激动为主要发病诱因,DWI高信号可能与静脉充盈有关.     

顽固性癫痫病灶切除的临床观察(附42例报告)

目的：探讨顽固性癫痫的手术治疗方法及疗效。方法：42例顽固性癫痫 术前定位后在皮层电图监测下对致痫灶予以切除。结果：42例随访3个月－报道如下4年，近期显效率为100％。结论：采用皮层电图监测下手术治疗顽固性癫痫是安全，有效的方法。     

一过性全面性遗忘症(附2例报告)

一过性全面性遗忘症（TransientGlobalAmnesia,TGA）,又称短暂性全脑性遗忘综合征,由Bender于1956年首次报道一例以一过性单纯遗忘发作为特征的病例,称之为伴有遗忘的精神错乱［1］,其后国外相继有不少报告,1958年由Fisher和Adams正式命名为TGA,近年国内、外均认为TGA为一种独立的疾病。临床表现为一过性逆行性遗忘为主的综合征。现将我们遇到的2例报告如下：并结合有关文献进行讨论。临床资料例1,女,64岁,大学教授。2小时前在家与客人谈话时,突然出现记忆障碍,不知客人姓名,不知所在何处,说话不对题,反复询问吃饭没有…     

短暂性完全遗忘综合征22例报告

目的：对22例短暂性完全遗忘综合征病人进行临床观察，并探讨其发病机理。方法：我们根据Caplan诊断标准诊断了22例TGA病人，行多普勒，头CT、MRI、MRA，脑电图，血流变等检查，分析了检查结果，查找TGA病因。结果：22例患均行多普勒检查，18例示椎－脊底动脉供血不足，4例正常。头CT检查，11例有腔隙性脑梗死，3例脑萎缩，8例未见异常。其中6人同时进行头MRI检查，其中3人腔隙性脑梗死，3例正常。20例脑电图检查，4例异常，血液流变学检测，均有不同程度血液流变学改变。结论：TGA经治疗预后良好。     

糖尿病性癫痫(附3例报告)

<正> 例1 男,57岁,工人。发作性右下肢抽搐10天。于2000年2月20日入院。每次发作持续1分钟至数分钟,发作频繁,每日3～5次.不伴意识丧失。既往有糖尿病史5年。外院拟诊癫痫给于苯妥因钠0.1/次,3次/日,治疗10天,症状无改善。空腹血糖22mmol/L,尿酮体(-)。诊断:糖尿病性癫痫。给小剂量胰岛素(5u/小时)持续静滴,并作血糖测定监护,随血糖下降,发作次数减少,至完全终止,后长期服降糖药物治疗,未再复发。     

脑磁图和视频脑电图在癫痫诊治中的应用(附337例报告)

目的探讨脑磁图(MEG)和视频脑电图(V-EEG)在癫痫诊治中的应用价值。方法本组应用MEG结合MRI、V-EEG对337例癫痫(其中174例为原发性癫痫,163例为继发性癫痫)患者行诊断及致痫灶定位检查;对本组251例(其中129例为原发性癫痫,122例为继发性癫痫)患者仅行抗癫痫药物治疗,86例(其中45例为原发性癫痫,41例为继发性癫痫)患者行手术治疗,治疗后6个月和1年均行MEG、V-EEG随访。结果 MEG检出癫痫患者319例,阳性检出率94.66%;V-EEG检出233例,阳性检出率69.14%。结合术中脑皮层电图监测,86例手术治疗的患者癫痫灶MEG精确定位率91.86%,V-EEG为61.63%,而对海马硬化检出率后者高于前者。药物治疗的251例癫痫患者6个月后复查MEG、V-EEG,治愈率31.87%,有效率达86.06%。手术治疗的86例患者术后6个月复查MEG、V-EEG,治愈率53.49%(46/86),有效率达90.70%(78/86)。结论脑磁图和视频脑电图的临床应用是癫痫诊治最为可靠的检测手段之一,也是判别癫痫发作类型,抗癫痫药物选择、评价药物疗效及选择停药时机的重要依据,对癫痫外科术前评估更是不可或缺的重要手段。     

Transient epileptic amnesia: An emerging late-onset epileptic syndrome

Transient epileptic amnesia (TEA) is a distinct neurologic condition occurring in late-middle/old age and presenting with amnesic attacks of epileptic nature and interictal memory disturbances. For many years this condition has been associated with the nonepileptic condition of transient global amnesia (TGA) and still today is poorly recognized by clinicians. Despite the clinical and laboratory findings that distinguish TEA from TGA, differential diagnosis may be difficult in the individual patient. Every effort must be employed for an early diagnosis, since antiepileptic treatment may readily control both ictal episodes and memory disturbances.     

Autobiographical memory and the self in a case of transient epileptic amnesia

Transient epileptic amnesia (TEA) is characterized by deficits in autobiographical memory (AM). One of the functions of AM is to maintain the self, suggesting that the self may undergo changes as a result of memory loss in temporal lobe epilepsy. To examine this, we used a modification of a task used to assess the relationship between self and memory (the IAM task) in a single case, E.B. Despite complaints of AM loss, E.B. had no difficulty in producing a range of self-images (e.g., I am a husband) and collections of self-defining AMs in support of these statements. E.B. produced fewer episodic memories at times of self-formation, but this did not seem to impact on the maintenance of self. The results support recent work suggesting the self may be maintained in the absence of episodic memory. The application of tasks such as that used here will further elucidate AM impairment in temporal lobe epilepsy.     

Transient epileptic amnesia: a neurosurgical case report

One memory disorder that is potentially treatable with antiepileptic drugs is transient epileptic amnesia (TEA). Working diagnostic consensus criteria for TEA include: (1) a history of recurrent witnessed episodes of transient amnesia; (2) confirmation by a reliable witness that cognitive functions other than memory are intact during typical episodes; and (3) evidence for a diagnosis of epilepsy. We describe a case with both complex partial seizures and episodes of TEA. This is the first reported case of a neurosurgical intervention for symptoms resembling those described in refractory TEA. Video/EEG, 3-T MRI, neuropathology, and neurological as well as neuropsychological findings are presented with postsurgical clinical outcome. The patient underwent right anterior amygdalohippocampectomy for symptoms resembling refractory TEA with additional complex partial seizures at our epilepsy surgical center. She remained seizure free at the 15-month follow-up, and memory complaints remitted. This case report illustrates one memory disorder, transient epileptic amnesia, that is potentially treatable with antiepileptic drugs or surgery.     

Compulsive versifying after treatment of transient epileptic amnesia

Compulsive production of verse is an unusual form of hypergraphia that has been reported mainly in patients with right temporal lobe seizures. We present a patient with transient epileptic amnesia and a left temporal seizure focus, who developed isolated compulsive versifying, producing multiple rhyming poems, following seizure cessation induced by lamotrigine. Functional neuroimaging studies in the healthy brain implicate left frontotemporal areas in generating novel verbal output and rhyme, while dysregulation of neocortical and limbic regions occurs in temporal lobe epilepsy. This case complements previous observations of emergence of altered behavior with reduced seizure frequency in patients with temporal lobe epilepsy. Such cases suggest that reduced seizure frequency has the potential not only to stabilize or improve memory function, but also to trigger complex, specific behavioral alterations.     

Ethmoidal meningioma revealed by transient global amnesia

A patient in whom transient global amnesia (TGA) led to the diagnosis of an ethmoidal meningioma is described. One year after neurosurgery, the patient showed an impairment of long-term memory, without any clinical or neuroradiological sign of relapse. We suggest that TGA may express a preexisting subclinical impairment of memory neuronal systems.

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Sommario Viene descritto un caso in cui un episodio di amnesia globale transitoria condusse alla diagnosi di meningioma etmoidale. Un anno dopo l'intervento chirurgico, la paziente presentava un deficit della memoria a lungo termine, senza segni clinici e neuroradiologici di recidiva. Gli Autori propongono che la TGA possa esprimere una preesistente compromiśsione subclinica dei circuiti neuronali della memoria.

     

Transient global amnesia as an epileptic manifestation

Summary The case of an 11-year-old girl with typical attacks of transient global amnesia is presented. The attacks occurred repeatedly and the EEG showed spike discharges in the right anterior temporal region. The disorder is assumed to be epileptic. Attacks and spike discharges disappeared immediately after beginning anticonvulsive therapy. Disorder of limbic structures that normally counteract the decay of stored information in memory units is discussed.

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Zusammenfassung Ein Fall eines elfjährigen Mädchens mit wiederholten Attacken einer transienten globalen Amnesie wird dargestellt. Im EEG fand sich ein rechts temporal vorn gelegener Spitzenherd. Eine Epilepsie wird angenommen. Nach der antikonvulsiven Therapie sistierten die Anfälle und der Spitzenherd wird unterdrückt. Die Funktionsstörung eines aktivierenden Systems innerhalb limbischer Strukturen, das normalerweise den Zerfall neu gespeicherter Informationen in den Zellen entgegenwirkt, wird diskutiert.

     

Similarity of symptoms between transient epileptic amnesia and Lewy body disease

Epilepsy with the main symptom of amnesia is known as transient epileptic amnesia (TEA). Dementia with Lewy bodies (DLB) is the second most common form of neurodegenerative dementia. The concept that Lewy body disease includes Parkinson's disease with dementia and dementia with Lewy bodies was proposed in the 2005 revision of the Clinical Diagnostic Criteria. Here, we describe a woman with cognitive impairment, olfactory dysfunction, and reduced ¹²³I‐meta‐iodobenzylguanidine uptake on myocardial scintigraphy. The patient and her family and friends were unaware of parkinsonism, visual hallucinations, or epilepsy for a long period. After syncope occurred twice within a short interval, electroencephalography revealed sharp waves from the bilateral frontal to parietal lobes, indicating a diagnosis of TEA. The present case prompted us to compare the symptoms of TEA with the clinical diagnostic criteria for dementia with Lewy bodies, revealing their similarities. We also discuss whether Lewy body disease may cause TEA rather than having an incidental association with it.     

Significance of serum neuron-specific enolase in transient global amnesia

Neuron-specific enolase (NSE) is a glycolytic enzyme, which is associated with neuronal cell dysfunction in the brain. This study evaluated the role of serum NSE levels of patients with transient global amnesia (TGA). In addition, the relationship between serum NSE levels and the clinical features of TGA was explored. Forty-eight patients with TGA were prospectively included, and their serum NSE levels were measured. We investigated serum NSE levels in patients with TGA. In addition, we analyzed the differences in clinical characteristics between patients with elevated and normal serum NSE levels. Of the 48 patients with TGA, 16 patients (33.3%) had elevated serum NSE levels (25.0 ± 11.5 ng/mL), whereas 32 patients (66.7%) showed normal serum NSE levels (12.8 ± 2.1 ng/mL). The patients with elevated serum NSE levels exhibited higher levels of cognitive impairment than those with normal serum NSE levels (4/16 vs. 1/32, p = 0.036). The serum NSE levels showed a relatively high discrimination (AUC 0.684) between patients with and without cognitive impairment, with 80.0% sensitivity and 74.4% specificity at a cut-off value 17.3 ng/mL. A third of all patients with TGA carry elevated serum NSE levels, which suggests that the neuronal cell dysfunction could be associated with TGA pathogenesis. In addition, it might be correlated with cognitive impairment.     

Cranial CT scan in transient global amnesia

The occurrence of cerebral infarction in patients with transient global amnesia (n = 43) was evaluated by CT scan and compared to that of patients with transient ischemic attacks (TIA) (n = 58) and with no neurological disease (n = 52). Significant differences were demonstrated between TGA and TIA patients in relation to the control group, but no differences were found between patients with TGA and TIA. Our study suggests a vascular mechanism for TGA and that TGA could be considered a low risk TIA in most cases.