AN INCREASED FREQUENCY OF PATENT FORAMEN OVALE IN PATIENTS WITH TRANSIENT GLOBAL AMNESIA - ANALYSIS OF 53 CONSECUTIVE PATIENTS

Objective: Alerted by the number of patients with transient global amn esia (TGA) in whom Valsalvalike activities immediately preceded the on set of TGA, we have investigated the frequency of patent foramen ovale (PFO) as the prerequisite for paradoxical embolism. Design: Case seri es with comparison to a control group. Setting: Hospitalized and ambul atory patients at the neurological departments of the Alfried Krupp Ho spital, Essen, Germany, and the Rheinisch-Westfalische-Technische Hoch schule, Aachen, Germany. Patients: Fifty-three consecutive patients wi th 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 weight s, immediately before the TGA occurred. Conclusions: In addition to ot her pathological mechanisms, paradoxical embolism with temporobasal is chemia could possibly play a role in the clinical syndrome of TGA. Thi s hypothesis could explain the frequent observation of preceding Valsa lvalike activities in patients with TGA.