Simultaneous transient global amnesia and right MCA stroke after Valsalva manoeuvre

A 61-year-old man suffered an episode of transient confusion and anterograde amnesia after a Valsalva-related manoeuvre. The MRI diffusion weighted imaging (DWI) sequences showed a left hippocampal and two right parietal lesions that were deemed as acute. The MR angiography disclosed a high-grade stenosis in the right middle cerebral artery as was described by a transcranial colour-coded ultrasound as well. Ultrasound investigation of the jugular veins showed a right jugular venous reflux after a Valsalva manoeuvre. The patient was diagnosed with transient global amnesia based on clinical grounds and the right parietal lesions were considered as silent strokes. The Valsalva manoeuvre could have played as a common trigger for both diseases.