Edit concept Question Editor Create issue ticket

Transient Global Amnesia


Presentation

Transient global amnesia will obviously present with acute memory loss and temporarily affected cognition. There is no other pertinent organ involvement unless there is an underlying organic cause like brain tumor or hepatic cancer on chemotherapy. The following signs and symptoms can present in patients with transient global amnesia:

  • Acute memory loss 
  • Ability to recall self-identity despite memory impairment
  • Normal cognition (e.g. recognize familiar objects and names)
  • No pertinent sign that leads to an organic brain lesion
  • Transient disorder of no more than 24 hours
  • Gradual return of memory
  • No medical history of seizure and epilepsy
Left Ventricular Dysfunction
  • Embolic stroke is a complication of Tako-Tsubo-cardiomyopathy (TTC), transient left ventricular dysfunction mimicking myocardial infarction without coronary culprit lesion explaining the whole left ventricular dysfunction.[ncbi.nlm.nih.gov]
Decompression Sickness
  • The diagnosis of decompression sickness may be difficult, particularly when patients present with atypical clinical manifestations after dives going on uneventfully and with full adherence to safety parameters.[ncbi.nlm.nih.gov]
Keratosis
  • Here we report on five patients who developed memory deficits such as transient global amnesia immediately after PDT for actinic keratosis. All PDT treatments were performed according to standard therapy protocols.[ncbi.nlm.nih.gov]
Musculoskeletal Pain
  • Whole-body cryotherapy (WBC), which consists of a short exposure to very cold and dry air in special 'cryo-chambers', is believed to reduce inflammation and musculoskeletal pain as well as improve athletes' recovery.[ncbi.nlm.nih.gov]
Upper Limb Weakness
Amnesia
  • Transient global amnesia and stroke. Eur Neurol. 1988 ; 28 :106-110. Crossref Medline Google Scholar 33 Fisher CM. Whiplash amnesia. Neurology. 1982 ; 32 :667-668. Crossref Medline Google Scholar 34 Fisher CM. Concussion amnesia.[stroke.ahajournals.org]
  • Abstract We prospectively identified patients with transient global amnesia in an urban population of 163,000. In 1982, 16 patients experienced their first transient global amnesia.[dx.doi.org]
  • With transient global amnesia, you do remember who you are, and you recognize the people you know well. Episodes of transient global amnesia always improve gradually over a few hours.[mayoclinic.com]
Confusion
  • A 61-year-old man suffered an episode of transient confusion and anterograde amnesia after a Valsalva-related manoeuvre.[ncbi.nlm.nih.gov]
  • Patients with this condition are often described--wrongly--as being confused. It presents classically with an abrupt onset of severe anterograde amnesia. It is usually accompanied by repetitive questioning.[ncbi.nlm.nih.gov]
  • A 57 years old female was admitted because of sudden confusion and loss of her memory after emotional stress. TGA was diagnosed.[ncbi.nlm.nih.gov]
  • If the person experiencing memory loss is too confused to call an ambulance, call one yourself.[mayoclinic.com]
  • […] verbal memory on neuropsychological tests, a possible metastatic tumor in the left temporal lobe by cerebral MRI, isolated wicket temporal spikes in the left mesial temporal area by sphenoidal electroencephalogram (EEG), and an additional brief phase of confusion[ncbi.nlm.nih.gov]
Memory Impairment
  • Baclofen-induced amnesia in rodents is a reliable model of memory impairment. In contrast, baclofen-induced memory impairment in humans is uncommon. Baclofen- associated transient global amnesia has not previously been reported.[ncbi.nlm.nih.gov]
  • Transient global amnesia comprises sudden changes in people's emotional state, which has a major impact on and interacts with episodic memory impairment.[ncbi.nlm.nih.gov]
  • Several studies noted persistence of memory impairment following an episode of transient global amnesia (TGA) with standard tests. To specify long-term memory impairments in a group of patients selected with stringent criteria.[ncbi.nlm.nih.gov]
  • However, the sudden occurrence of memory impairment can be especially alarming to an individual who has recently arrived in an unfamiliar setting. The cause of TGA remains unknown.[ncbi.nlm.nih.gov]
  • A wide spectrum of symptoms of neural dysfunction following hyperoxic mixtures have been reported, including cases of memory impairment related to previous generalized convulsions.[ncbi.nlm.nih.gov]
Perseveration
  • Our patient is a 64-year-old white man with a previous history of myocarditis from borreliosis who developed sudden-onset confusional state with perseverations and repetition of the same questions during a funeral for his brother-in-law.[ncbi.nlm.nih.gov]
  • One of its bizarre features is perseveration, in which the victim of an attack faithfully and methodically repeats statements or questions, complete with profoundly identical intonation and gestures "as if a fragment of a sound track is being repeatedly[en.wikipedia.org]
  • Due to the sudden-onset of symptoms, anxiety is common, and it is typical for patients to perseverate, asking the same questions repeatedly- often with similar gestures and vocal intonation [ 1 , 3 , 6 ].[omicsgroup.org]
  • This condi-tion is also associated with an observed higher level of anxiety and agitation, leading to perseveration. Patients will ask the same questions over and over again, usually within minutes of having received an answer.[web.archive.org]
Temporary Amnesia
  • Medical Definition of transient global amnesia : temporary amnesia of short duration (as several hours) that is marked by sudden onset, by loss of past memories, and by an inability to form new memories, and that is believed to result from a transient[merriam-webster.com]
  • TEA attacks tend to be short (under one hour) and tend to recur, so that a person who has experienced both repeated attacks of temporary amnesia resembling TGA and if those events lasted less than one hour is very likely to develop epilepsy.There is additional[en.wikipedia.org]
  • amnesia resembling TGA and if those events lasted less than one hour is very likely to develop epilepsy. [2] There is additional speculation that atypical cases of TEA in the form of nonconvulsive status epilepticus may present with duration similar[en.wikipedia.org]

Workup

Patients are evaluated extensively on neurologic examination to rule out organic brain disorders like stroke, concussion, and seizure that can mimic the signs of transient global amnesia. Cognitive test of judgment and memory may also be applied routinely. These imaging test will confirm brain pathology like tumors, impaired blood circulation and electrical activity:

  • Electroencephalogram (EEG): These records the brain electrical activity from electrode to the scalp of the head. This test can detect the abnormal patterns of brainwave activity in seizure disorder [10].
  • Magnetic Resonance Imaging (MRI): This imaging technique can reveal masses or circulatory problems in the brain matter.
  • Computed Tomography (CT) Scan: CT scans may demonstrate brain tumors and vascular pathology. It may also demonstrate an old infarct or a past brain hemorrhage in those with past history of stroke. 

Treatment

Transient global amnesia requires no treatment. The amnesia resolves on its own with no known side effects.

Prognosis

The prognosis for transient global amnesia is generally good. Loss of memory is usually short-lived and lasts within 24 hours from the attack. The state of amnesia may improve upon resolution but recent memory lost during the attack may never be remembered by the patients. The recurrence rate for the disorder is only 5-25% which are usually found in migraine and seizure cases. Transient global amnesia does not increase the likelihood of cerebrovascular disease like stroke.

Complications

Transient global amnesia has no direct medical complication. However, patients who undergo the episode may feel anxious because of the fear of recurrence or the fear of a more serious underlying neurologic disease like brain tumor may be at play. A strong emotional support or an encompassing psychotherapy may allay the anxiety which may lead to depression if left unchecked.

Etiology

The exact etiology of transient global amnesia is still unclear. There has been some strong correlation with the occurrence of migraines but direct linkage is still not well-established. The following common events has been observed to trigger attacks of transient global amnesia:

Epidemiology

In the United States, the current incidence of transient global amnesia reaches 5.2 cases per 100,000 population. However, elderly people beyond age 50 years old may reach a case specific incidence rating of up to 23.5 cases per 100,000 annually [3]. Internationally, studies in Alcoi, Spain has a lower incidence of 2.9 cases per 100,000 citizens [4].

The Italians in Belluno were noted to have a higher incidence reaching up to 10 cases of transient global amnesia out of 100,000 population [5]. Although attacks of transient global amnesia rarely recurs, studies have shown that it may reach a recurrence rate of up to 24% in one lifetime.

There are no observable racial and sexual predilection of the disease across all cultures. Transient global amnesia typically occurs at the age of fifty years old. Females usually incurs transient memory loss following an emotional distress, or severe anxiety, while male counterparts succumbs to transient amnesia following a strenuous physical activities like sports.

Sex distribution
Age distribution

Pathophysiology

The definite pathophysiology of transient global amnesia remains unclear up to this point. However, advances in neurology research and real-time imaging techniques have elucidated some plausible theories on occurrence and pathology. Real time positron emission tomography (PET) and diffuse weighted magnetic resonance imaging (DWI) have demonstrated a transient ischemia in the brain regions of the thalamus and the mesial temporal structures involved in memory processing.

However, DWI may have a lower yield in picking up transient global amnesia when performed early in its course [6]. Other studies reveal that minute lesions of the hippocampus as revealed by DWI has been associated with transient global amnesia [7].

Other dominant theories suggest the role of edema and the spreading depression in the left frontal cortex of the brain contribute to the transient memory loss [8]. Single photon emission computed tomography (SPECT) has demonstrated real time hypoperfusion of the cerebral mater coincides with the transient global amnesia attacks [9]. In the same way, cerebellar hypoperfusion may also give out similar transient neurologic deficits.

Prevention

There is no modifiable lifestyle approach to prevent transient global amnesia.

Summary

Transient global amnesia (TGA) is clinical disease characterized by a sudden loss of memory which lasts temporarily that is not a part of any organic neurologic illnesses like cerebrovascular disease (stroke) or epilepsy.

Transient global amnesia injures memory loss of recent memory or events that happens within hours (within 24 hours) from the attack. Immediate memory recall and distant memory are usually preserved during the paroxysmal attacks of memory loss. Attacks of transient global amnesia may be short and fleeting and may rarely recur in patients.

Patient Information

Definition

Transient global amnesia is a temporary loss of memory that resolves within 24 hours. This disorder is not serious and is not associated with any brain pathology.

Cause

The exact cause is unknown but it is associated with conditions like emotional outbreak and strenuous physical activity. 

Symptoms

Paroxysmal or transient loss of recent memory that resolves within 24 hours. The past memory are preserved in all cases.

Diagnosis

A meticulous history taking and interview of witnesses may suggests the diagnosis of transient global amnesia. Imaging techniques and electroencephalogram can rule out other organic causes like stroke, tumor or seizure disorders.

Treatment and follow-up

No treatment is required for it resolves spontaneously. Recurrence is relatively rare.

References

Article

  1. Saura D, Peñafiel P, Morales A, Albert L, Martínez F, de la Morena G. Transient global amnesia after dobutamine--atropine stress echocardiography. Eur J Echocardiogr. Jul 2008; 9(4):567-8.
  2. Zardi EM, Zardi DM, Lazarevic Z, Santucci S, D'Errico F, Afeltra A, Tonioni S. Transient global amnesia as the first symptom of primary antiphospholipid syndrome: a case report. Int J Immunopathol Pharmacol. 2012; 25(1):275-80 (ISSN: 0394-6320)
  3. Miller JW, Petersen RC, Metter EJ, et al. Transient global amnesia: clinical characteristics and prognosis.Neurology. May 1987; 37(5):733-7. 
  4. Matias-Guiu J, Blanquer J, Falip R, et al. Incidence of transient global amnesia in a Alcoi (Spain). Acta Neurol Scand. Aug 1992; 86(2):221.
  5. Lauria G, Gentile M, Fassetta G, et al. Incidence of transient global amnesia in the Belluno province, Italy: 1985 through 1995. Results of a community-based study. Acta Neurol Scand. May 1997; 95(5):303-10.
  6. Ahn S, Kim W, Lee YS, Kim WY, Lee JH, Oh BJ, Lim KS. Transient global amnesia: seven years of experience with diffusion-weighted imaging in an emergency department. Eur Neurol. 2011; 65(3):123-8 (ISSN: 1421-9913)
  7. Liang JF, Shen AL, Lin SK. Bilateral hippocampal abnormalities on diffusion-weighted MRI in transient global amnesia: report of a case. Acta Neurol Taiwan. Jun 2009; 18(2):127-9.
  8. Strupp M, Bruning R, Wu RH, et al. Diffusion-weighted MRI in transient global amnesia: elevated signal intensity in the left mesial temporal lobe in 7 of 10 patients. Ann Neurol. Feb 1998; 43(2):164-70.
  9. Yamane Y, Ishii K, Shimizu K, Sofue K, Yoshikawa T, Miyamoto N, et al. Global cerebral hypoperfusion in a patient with transient global amnesia. J Comput Assist Tomogr. May-Jun 2008; 32(3):415-7.
  10. Cabrera-Naranjo F; Saiz-Diaz RA; Gonzalez-Hernandez A; de la Pena-Mayor P; Gonzalez de la Aleja J. Usefulness of electroencephalograms in evaluating transient global amnesia .Rev Neurol. 2012; 55(2):81-6 (ISSN: 1576-6578)

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2019-07-11 20:37