RESIDENT & FELLOW SECTION Teaching NeuroImages: Convexal subarachnoid hemorrhage accompanied by transient global amnesia Markus Beitzke, MD, Christian Enzinger, MD, and Franz Fazekas, MD ® Neurology 2018;90:e1933-e1934. doi:10.1212/WNL.0000000000005567 Correspondence Dr. Beitzke markus.beitzke@ klinikum-graz.at Figure Brain CT and MRI Brain CT showed a hyperdense signal in several sulci of the left frontal lobe consistent with convexal subarachnoid hemorrhage (arrows) (A). MRI revealed a small bright diffusionweighted imaging–positive lesion (arrow) in the right hippocampus (B). Corresponding apparent diffusion coefficient map shows decreased diffusivity (arrow) (C). A 55-year-old otherwise healthy woman presented with sudden-onset anterograde amnesia, temporal disorientation, and repetitive questioning, which was associated with moderate intensity headache. Consistent with transient global amnesia (TGA), this clinical symptomatology lasted for 8 hours. Brain imaging showed a convexal subarachnoid hemorrhage1 (cSAH) (figure, A) and—characteristic of TGA2—a punctuate diffusion-weighted imaging positive lesion in the right hippocampus on MRI (figure, B and C). Cerebral microbleeds or cortical superficial siderosis were not evident on acute MRI. MORE ONLINE Teaching slides links.lww.com/WNL/ A479 The clinical manifestations of cSAH are diverse, including transient focal neurologic episodes, while headache is frequently absent.1 After TGA, punctuate hippocampal diffusion-weighted imaging–positive lesions appear in up to 80% of patients.2 The present observation suggests that cSAH may trigger a TGA, while a random coincidence appears unlikely. Author contributions M.B. took care of the patient. All authors interpreted imaging findings and wrote the report. From the Department of Neurology (M.B., C.E., F.F.) and Division of Neuroradiology, Department of Radiology (C.E.), Medical University of Graz, Austria. Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article. Copyright © 2018 American Academy of Neurology Copyright ª 2018 American Academy of Neurology. Unauthorized reproduction of this article is prohibited. e1933 e1934 Study funding No targeted funding reported. 1. Disclosure The authors report no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures. 2. Neurology | Volume 90, Number 21 | May 22, 2018 References Beitzke M, Gattringer T, Enzinger C, Wagner G, Niederkorn K, Fazekas F. Clinical presentation, etiology, and long-term prognosis in patients with nontraumatic convexal subarachnoid hemorrhage. Stroke 2011;42: 3055–3060. Förster A, Griebe M, Gass A, Kern R, Hennerici MG, Szabo K. Diffusion-weighted imaging for the differential diagnosis of disorders affecting the hippocampus. Cerebrovasc Dis 2012;33:104–115. Neurology.org/N Copyright ª 2018 American Academy of Neurology. Unauthorized reproduction of this article is prohibited. Teaching NeuroImages: Convexal subarachnoid hemorrhage accompanied by transient global amnesia Markus Beitzke, Christian Enzinger and Franz Fazekas Neurology 2018;90;e1933-e1934 DOI 10.1212/WNL.0000000000005567 This information is current as of May 21, 2018 Updated Information & Services including high resolution figures, can be found at: http://n.neurology.org/content/90/21/e1933.full.html References This article cites 2 articles, 1 of which you can access for free at: http://n.neurology.org/content/90/21/e1933.full.html##ref-list-1 Subspecialty Collections This article, along with others on similar topics, appears in the following collection(s): All Clinical Neurology http://n.neurology.org//cgi/collection/all_clinical_neurology MRI http://n.neurology.org//cgi/collection/mri Subarachnoid hemorrhage http://n.neurology.org//cgi/collection/subarachnoid_hemorrhage Permissions & Licensing Information about reproducing this article in parts (figures,tables) or in its entirety can be found online at: http://n.neurology.org/misc/about.xhtml#permissions Reprints Information about ordering reprints can be found online: http://n.neurology.org/misc/addir.xhtml#reprintsus Neurology ® is the official journal of the American Academy of Neurology. Published continuously since 1951, it is now a weekly with 48 issues per year. Copyright © 2018 American Academy of Neurology. All rights reserved. Print ISSN: 0028-3878. Online ISSN: 1526-632X.