Evidence of Myocardial Ischemia Often Found in Transient Global Amnesia

Evidence of myocardial injury was found in roughly a quarter of patients with transient global amnesia.

Myocardial injury is relatively common in patients with transient global amnesia (TGA) based on elevations of cardiac troponin (cTn) levels, according to the results of a case-control study published in the European Journal of Neurology.

Data of consecutive patients with TGA between 2010 and 2015 were included in the study. In an analysis adjusting for age, sex, and cardiovascular risk factors, the researchers compared the likelihood of myocardial injury (ie, elevation of cTn >99th percentile and ≥14 ng/L) in patients presenting with migraine with aura, vestibular neuritis, and transient ischemic attack (TIA).

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Data for a total of 113 patients were included in the final analysis. The investigators evaluated case files, electrocardiogram (ECG) findings (rhythm, heart rate, ST depression or elevation, and T wave inversion), and laboratory results for signs of myocardial infarction, heart failure, takotsubo cardiomyopathy, severe anemia, respiratory failure, or sepsis.

Approximately 25% of the overall study cohort had elevated cTn levels and patients with cTn elevations were often older, female (51 vs 21; P =.04) had lower creatinine levels (0.89 mg/dl vs 0.81 mg/dl; P =.03), and had higher blood pressure at time of admission compared with patients without elevated cTn.

There was a 2-fold higher likelihood of myocardial injury in patients who had TGA vs patients in the 3 reference groups (vs migraine with aura: adjusted odds ratio [aOR], 5.5; 95% CI, 1.2-26.4; vs vestibular neuritis, aOR, 2.2, 95% CI, 1.2-4.4; vs TIA, aOR, 2.3; 95% CI, 1.3-4.2).

Study limitations include the case-control design, as well as the small number of participants.

The findings from this study “suggest a pathophysiological role of the central autonomic network with sympathetic activation in TGA. The detection of hs-cTn elevation, which is associated with cardiovascular disease, warrants further research to clarify the clinical relevance and management of hs-cTn elevation in patients with TGA and other acute neurological disorders.”


Erdur H, Siegerink B, Ganeshan R, et al. Myocardial injury in transient global amnesia: a case-control study [published online January 31, 2019]. Eur J Neurol. doi:10.1111/ene.13920