He Keeps Repeating Himself, Himself, Himself….

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    He Keeps Repeating Himself, Himself, Himself….

    A 60 year-old male patient with a history of hypertension is BIBEMS with his spouse two hours of sudden onset memory loss. She noticed he began asking her if she wanted coffee every 3 or 4 minutes, apparently not remembering he had already asked.  He knows his name, where he is, and the date. He correctly states the name of the President of the United States. He is calm but keeps repeating himself every few minutes. His vitals are normal, and his neurologic exam is normal.

    1.What is the diagnosis?

    2. If imaging were to be acquired, what would be the most likely finding on a non-contrast CT?

    3. What is the treatment?

    4. What is the prognosis of patients with this condition?


    Transient Global Amnesia (TGA) is acute anterograde memory loss (unable to form new memories) in the absence of other clinical features. The syndrome resolves spontaneously within 24 hours. Imaging is not required for diagnosis and is most likely normal. There is no treatment other than time. Compared to age-matched controls TGA patients have no change in mortality or cerebrovascular disease. TGA patients’ long-term risks are better than those compared with patients with transient ischemic attacks. The key is to recognize this entity and rule out dangerous mimics including stroke and seizure.

    References:

    Hodges JR, Warlow CP. The aetiology of transient global amnesia. A case-control study of 114 cases with prospective follow-up. Brain : a journal of neurology. Jun 1990;113 ( Pt 3):639-657. (Case-control study. 114 TGA patients, 109 normal controls, 212 TIA controls).

    Basior J, Vogel S, Mitton J. Transient global amnesia: diagnosis in the emergency department. The American journal of emergency medicine. Jul 1985;3(4):352-357. (Retrospective chart review, 20 patients). 

    Hodges JR, Warlow CP. Syndromes of transient amnesia: towards a classification. A study of 153 cases. Journal of neurology, neurosurgery, and psychiatry. Oct 1990;53(10):834-843. (Retrospective cohort, 153 cases). 

    Harrison M, Williams M. The diagnosis and management of transient global amnesia in the emergency department. Emergency medicine journal : EMJ. Jun 2007;24(6):444-445. (Rewiew).

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