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Analysis of 53 Consecutive Patients

Christof Klötzsch, MD; Ulrich Sliwka, MD; Peter Berlit, MD; Johannes Noth, MD

Arch Neurol. 1996;53(6):504-508.

Abstract
Objective
Alerted by the number of patients with transient global amnesia (TGA) in whom Valsalvalike activities immediately preceded the onset of TGA, we have investigated the frequency of patent foramen ovale (PFO) as the prerequisite for paradoxical embolism.

Design
Case series with comparison to a control group.

Setting
Hospitalized and ambulatory patients at the neurological departments of the Alfried Krupp Hospital, Essen, Germany, and the Rheinisch-Westfälische-Technische Hochschule, Aachen, Germany.

Patients
Fifty-three consecutive patients with TGA were evaluated by the 2 centers between 1988 and 1995.

Results
Using contrast transcranial Doppler sonography we have observed a PFO in 55% of the patients with TGA, compared with 27% of a control group of 100 patients. This difference was statistically significant (P<.01). Twenty-five patients with TGA (47%), 15 of them with a proven PFO, reported a precipitating activity, such as the lifting of heavy weights, immediately before the TGA occurred.

Conclusions
In addition to other pathological mechanisms, paradoxical embolism with temporobasal ischemia could possibly play a role in the clinical syndrome of TGA. This hypothesis could explain the frequent observation of preceding Valsalvalike activities in patients with TGA.

Author Affiliations
From the Departments of Neurology, Alfried Krupp Hospital, Essen, Germany (Drs Klötzsch and Berlit) and Rheinisch-Westfälische-Technische Hochschule, Aachen, Germany (Drs Sliwka and Noth).

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