Transcranial direct current stimulation (tDCS) is an upcoming treatment modality for patients with schizophrenia. A series of recent observations have demonstrated improvement in clinical status of schizophrenia patients with tDCS. This review summarizes the research work that has examined the effects of tDCS in schizophrenia patients with respect to symptom amelioration, cognitive enhancement and neuroplasticity evaluation. tDCS is emerging as a safe, rapid and effective treatment for various aspects of schizophrenia symptoms ranging from auditory hallucinations-for which the effect is most marked, to negative symptoms and cognitive symptoms as well. An interesting line of investigation involves using tDCS for altering and examining neuroplasticity in patients and healthy subjects and is likely to lead to new insights into the neurological aberrations and pathophysiology of schizophrenia. The mechanistic aspects of the technique are discussed in brief. Future work should focus on establishing the clinical efficacy of this novel technique and on evaluating this modality as an adjunct to cognitive enhancement protocols. Understanding the mechanism of action of tDCS as well as the determinants and neurobiological correlates of clinical response to tDCS remains an important goal, which will help us expand the clinical applications of tDCS for the treatment of patients with schizophrenia.
Hallucinations ; Humans ; Neurobehavioral Manifestations ; Neuronal Plasticity ; Schizophrenia*

Background and purpose: Transient global amnesia (TGA) is a rare amnestic syndrome characterized by the sudden onset of a selective anterograde and retrograde amnesia with a time course of up to 24 hours. Recent studies have found a high frequency of small high-signal abnormalities in the hippocampus on diffusion-weighted imaging (DWI), and accordingly ischemia has been proposed as an etiology of TGA. We hypothesized that TGA lesions occur preferentially in the CA1 region of the hippocampus, which is known to be susceptible to ischemia. Methods: Twenty consecutive patients with a clinical diagnosis of TGA underwent DWI both within 24 hours of symptom onset and 3 days later. Twenty patients with high-signal abnormalities in the hippocampus on the initial DWI underwent subsequent DWI and T2-weighted imaging in the coronal plane to precisely localize the lesions. Results: Seventeen patients had small high-signal abnormalities (with diameters of 1-3 mm) in the hippocampus unilaterally on DWI. One of these patients had two lesions in one hippocampus. Three of the 20 patients had lesions bilaterally in the hippocampus, 1 of whom had 3 bilateral lesions. A total of 25 lesions were identified: 5 in the hippocampal head, 19 in the body, and 1 in the tail. Six patients had unilateral lesions on the left,11 patients had them on the right, and 3 patients had bilateral lesions. Conclusions: In this study, lesions associated with TGA were localized mostly to the lateral portion of the hippocampus, corresponding to CA1. This finding supports the ischemic etiology of TGA, but the underlying pathophysiologic mechanism requires further investigation.
Amnesia, Retrograde ; Amnesia, Transient Global ; Head ; Hippocampus ; Humans ; Ischemia

Transient global amnesia(TGA) is not a rare event in the elderly, which is characterized by transient inability to form the new memory traces plus retrograde amnesia with benign prognosis. The etiology is unknown, but suggested causes have included transient ischemic attack, migraine, epilepsy, brain tumor, drug intoxication, other toxic/metabolic disturbances, or hysteria. Especially, TGA associated with ischemic stroke is important on the elderly patients and necessary to be differentiated with other causes, for stroke prevention. As far as we know, the case of TGA due to cerebral infarction confirmed by brain imaging study is extremely rare in the literature. We report the case of 67 year-old female patient with typical TGA showing ischemic lesion on the right temporal area on MRI and discussed its significance as one of the cause of TGA.
Aged ; Amnesia, Retrograde ; Amnesia, Transient Global* ; Brain Neoplasms ; Cerebral Infarction ; Epilepsy ; Female ; Humans ; Hysteria ; Infarction* ; Ischemic Attack, Transient ; Magnetic Resonance Imaging ; Memory ; Migraine Disorders ; Neuroimaging ; Prognosis ; Stroke

OBJECTIVE: This study explored the phenomenology of delirium in cancer patients, and evaluated the severity of delirium according to the cancer treatment method and the use of sedative-hypnotics, including zolpidem. METHODS: This was a retrospective chart review study. Cancer patients with delirium, who were referred to the Department of Psychiatry at a National University hospital, were included in the analysis. In all subjects, the severity of delirium was assessed using the Delirium Rating Scale-Revised-98 (DRS-R-98). RESULTS: The analysis included 112 patients with delirium. Among the neuropsychiatric and behavioral symptoms, the most frequent ones were sleep-wake cycle disturbance (100.0%) and perceptual disturbances and hallucinations (95.5%). Among the cognitive symptoms, inattention (98.2%) was the most frequent. The older the patients were, the higher the DRS-R-98 total scores were. There was no significant difference in the DRS-R-98 scores among cancer treatment methods (operation, chemotherapy, or radiation therapy). However, the total DRS-R-98 scores in the zolpidem use group were higher than in control group, and the difference was significant after adjusting for age, sex, and type of cancer treatment. CONCLUSION: Sleep-wake cycle disturbance, inattention, and perceptual disturbances were the most common delirium symptoms in cancer patients. The severity of delirium in patients taking zolpidem was significantly greater.
Behavioral Symptoms ; Benzodiazepines ; Delirium ; Hallucinations ; Humans ; Neurobehavioral Manifestations ; Pyridines ; Retrospective Studies

BACKGROUND AND PURPOSE: Transient global amnesia (TGA) is a stereotypic condition characterized by anterograde and retrograde amnesia that typically resolves within 24 hours. The pathophysiology of TGA is still unclear. We noted that patients hospitalized with TGA tend to appear in seasonal clusters, and decided to investigate this phenomenon. METHODS: Every patient with acute presentation of amnesia at our medical center is hospitalized for observation and evaluation. We reviewed the monthly occurrence of TGA in our patient population between 2000 and 2014, and compared this to non-TGA hospitalizations during the same time period. RESULTS: During the analysis period, 154 patients who met the criteria for TGA were hospitalized, as well as 259,007 non-TGA hospitalizations. The annual occurrence of TGA ranged from 5 to 16 hospitalizations. There were 91 TGA events in women and 63 in men, in subjects aged 62.8±10.6 years (mean±SD). The incidence was maximal during December [odds ratio (OR)=2.83, 95% confidence interval (CI)=1.20–6.67] and March (OR=2.77, 95% CI=1.17–6.56), and minimal from April to August. The incidence exhibited an increase followed by a decrease from October to February. A seasonal trend was observed as well, with incidence peaks occurring in winter (OR=1.82, 95% CI=1.12–2.96) and spring (OR=1.80, 95% CI=1.10–2.94). CONCLUSIONS: Our findings suggest that the incidence of TGA exhibits seasonal variations. This observation may help to improve the understanding of the pathophysiology underlying TGA.
Amnesia ; Amnesia, Retrograde ; Amnesia, Transient Global* ; Female ; Hospitalization ; Humans ; Incidence* ; Male ; Seasons*

BACKGROUND: The dot-like hippocampal signal intensity in diffusion-weighted MR images is well-known as a characteristic imaging feature in transient global amnesia, a neurological syndrome in which sudden forward-and-backward memory loss occurs that is slowly recovered within 24 hours. We here report on patients with this dot-like hippocampal hyperintensity who did not present with anterograde amnesia except for headaches. CASE REPORT: Two women without a specific medical history presented with sudden-onset headaches on the same day. Neither had any trauma or infection history before the symptom or any sudden emotional or postural changes. Brain MRI showed tiny hippocampal high signal intensity on diffusion-weighted images (DWI). CONCLUSIONS: Dot-like hippocampal lesions seen on DWI may be present without memory impairment, and more studies are needed to determine whether there is any association with headache as in this case.
Amnesia, Anterograde ; Amnesia, Transient Global* ; Brain ; Diffusion* ; Female ; Headache* ; Hippocampus ; Humans ; Magnetic Resonance Imaging ; Memory ; Memory Disorders

We report two patients who complained of transient anterograde amnesia and repetitive questioning, that developed after taking zolpidem and lasted for several hours. The clinical manifestations of these patients fulfill the clinical criteria for transient global amnesia (TGA). The typical clinical manifestation of TGA following the consumption of zolpidem suggests a possible relationship associated with its drug mechanism.
Amnesia, Anterograde ; Amnesia, Transient Global ; Humans

Transient global amnesia (TGA) is an amnesic disorder which is characterized by temporary loss of anterograde and recent retrograde memory with preserved consciousness. Though the pathogenesis of TGA is still unclear, current hypotheses include migraine, seizure, or cerebral ischemia. We present three patients with TGA who showed signal intensity change in diffusion weighted image in hippocampus. These findings might suggest that ischemia in hippocampus might be the cause of the TGA.
Amnesia, Transient Global* ; Brain Ischemia ; Consciousness ; Diffusion* ; Hippocampus* ; Humans ; Ischemia ; Memory ; Migraine Disorders ; Seizures

Transient global amnesia (TGA) is characterized by abrupt onset temporary dysfunction of anterograde and retrograde amnesia without other neurologic deficits. We encountered a 53-year-old man who developed recurrent TGA while working in a hot and humid machinery room (33degrees C and 64% relative humidity). Heat exposure and physical exertion may facilitate the leakage of cytokines into the systemic circulation so as to cause a cerebral endothelial insult. Functional insufficiency of the hippocampus and its connections caused by physical and environmental factors may be related to recurrent attacks.
Amnesia, Retrograde ; Amnesia, Transient Global* ; Cytokines ; Hippocampus ; Hot Temperature ; Humans ; Middle Aged ; Neurologic Manifestations ; Physical Exertion

Transient global amnesia (TGA) causes retrograde amnesia, but there have been few reports of retrograde amnesia as a presenting symptom in TGA. A 52-year-old male who had acute amnesia for the past 4 years presented with TGA and recovered within 1 day. Brain magnetic resonance imaging revealed a lesion in the left hippocampus, and brain single-photon emission computed tomography revealed decreased blood flow in the left temporal and frontal areas. We speculated that hippocampal lesion with a frontal perfusion defect can be a cause of TGA.
Amnesia ; Amnesia, Retrograde ; Amnesia, Transient Global ; Brain ; Hippocampus ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Perfusion ; Tomography, Emission-Computed