Bilateral Hippocampus Changes on MRI in Transient Global Amnesia

AbstractTransient Global Amnesia (TGA) is a dynamic condition. An undefined event causesanterograde amnesia (sometimes with retrograde amnesia) that lasts in a day and preserves ofself-identity and of consciousness. Epilepsy, migraine and ischemic events are the possiblecauses for different hypothesis but still unproven. Sixty three years old woman admitted toemergency department because of amnesia. She felt ill herself and was repeatedly askingsimilar questions and making same sentences in that period. She was not remember doingthings nearby, but she was fully conscious to time, places, herself and her relatives.Neurological examination was normal except the anterograde and partly retrograde amnesia.Within amnesic period, Isotropic Diffusion Weighted Imaging (DWI) and ADC (ApparentDiffusion Coefficient) maps revealed hyper and hypo intensities on MRI respectively at bothhippocampus (slightly more prominent at left side) while T1, T2 weighted and FluidAttenuated Inversion recovery (FLAIR) images were normal. T1W+C images revealedbilateral contrast enhancements at hippocampus, and more prominent at the left side. Bilateralhippocampus MRI signal changes in our patient within the amnesic period are the reflectionsof the abnormal cellular functions in a TGA patient

Diagnostic value of "dysphagia limit'' for neurogenic dysphagia: 17 years of experience in 1278 adults

WOS: 000349616700027PubMed ID: 25088732Objective: Neurogenic dysphagia (ND) is a prevalent condition that accounts for significant mortality and morbidity worldwide. Screening and follow-up are critical for early diagnosis and management which can mitigate its complications and be cost-saving. The aims of this study are to provide a comprehensive investigation of the dysphagia limit (DL) in a large diverse cohort and to provide a longitudinal assessment of dysphagia in a subset of subjects. Methods: We developed a quantitative and noninvasive method for objective assessment of dysphagia by using laryngeal sensor and submental electromyography. DL is the volume at which second or more swallows become necessary to swallow the whole amount of bolus. This study represents 17 years experience with the DL approach in assessing ND in a cohort of 1278 adult subjects consisting of 292 healthy controls, 784 patients with dysphagia, and 202 patients without dysphagia. A total of 192 of all patients were also reevaluated longitudinally over a period of 1-19 months. Results: DL has 92% sensitivity, 91% specificity, 94% positive predictive value, and 88% negative predictive value with an accuracy of 0.92. Patients with ALS, stroke, and movement disorders have the highest sensitivity (85-97%) and positive predictive value (90-99%). The clinical severity of dysphagia has significant negative correlation with DL (r = -0.67, p < 0.0001). Conclusions: We propose the DL as a reliable, quick, noninvasive, quantitative test to detect and follow both clinical and subclinical dysphagia and it can be performed in an EMG laboratory. Significance: Our study provides specific quantitative features of DL test that can be readily utilized by the neurologic community and nominates DL as an objective and robust method to evaluate dysphagia in a wide range of neurologic conditions. (C) 2014 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved