확산강조 자기공명영상에서 양측 해마에 작은 고신호 강도 병변을 보인 일과성 전기억상실증 1예
A Case of Transient Global Amnesia with Two Tiny High Signal Intensities at the Head of Both Hippocampi on Diffusion-Weighted Magnetic Resonance Imaging
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초록
본 증례에서 TGA 발생 48시간 후에 실시한 MRI의 T1 강조영상에서 이상 소견이 발견되지 않았고 T2 강조영상에서 경미한 신호 강도의 변화를 보였으나, DWI에서는 양측 해마에 분명한 작은 고신호 강도의 병변이 발견되었다. 이러한 사실은 DWI가 TGA의 초기 단계를 탐지하는 데 민감하면서도 유용한 검사 도구임을 확인시켜 주었다. 아울러 본 증례는 TGA 발생 이전에 심한 심리적 스트레스를 경험하다가 Valsalva maneuver가 동시에 일어나면서 TGA가 발생된 경우로서 TGA의 발생 기전에 있어서 뇌 정맥압 상승으로 인한 뇌 정맥 울혈/허혈의 중요성을 지지해 준다.
Abstract
We report on a patient with transient global amnesia (TGA) showing increased tiny signal intensities at the head of both hippocampi on diffusion-weighted image (DWI) performed on the second day after the onset of symptoms. The T1-weighted image using 3-tesla magnetic resonance imaging (MRI) showed no signal changes, but the T2-weighted image showed slight signal changes at the same portion of both hippocampi. Single photon emission computed tomography (SPECT) performed on the 4th day after the onset of TGA showed no perfusion abnormalities. This patient experienced an extreme emotional stress before the onset of TGA, and the patient's TGA started by a simultaneous Valsava-like maneuver. We discuss the venous congestion/ ischemia hypothesis for TGA. This case confirms that DWI is a sensitive and useful tool for evaluating the early stage of TGA. (J Korean Neuropsychiatr Assoc 2007;46(5):523-527)
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