![]() In the meantime, she has developed new mild ataxia. She has not repeated any questions during the past 2 hours and remembers your latest conversations. Twenty hours later, her amnesia has fully resolved. You place her on hospital involuntary hold. You explain to her repeatedly that, because she is not encoding memories, she cannot be discharged, and lacks decisional capacity. She states that she feels fine and wants to sign out against medical advice. She also complains of a mild diffuse headache, but she has no other symptoms and is found to be neurologically and, otherwise, cognitively normal. She demonstrates clear anterograde amnesia, failing to remember you on multiple occasions. In the ED, the patient is alert and oriented to self and place, but not to time. EMS providers detected no stroke symptoms and transported her to your ED. She was smoking a cigarette with her friend when she became confused and started asking, “How did we get here?” repeatedly. You wonder if you should activate the stroke team and order an emergent CT of the brain.Ī 54-year-old woman with hypertension presents with sudden memory loss. When you step away and subsequently return to the bedside a few minutes after the initial encounter, the patient does not recognize you and asks, “Have we met before?” The patient has no other complaints, and there are no neurologic or infectious symptoms. ![]() He is perseverating about what he was doing 1 hour ago. He knows what he did yesterday and this morning but cannot seem to recall events of the past few hours. The patient is calm, cooperative, and oriented to person, place, and time, but he frequently repeats himself and does not appear to be forming new memories. His wife has been with him since the onset of symptoms, when he started asking her the same question repeatedly every few minutes. Opening CasesĪ 60-year-old man with no significant medical history is brought to the ED by EMS after 2 hours of sudden memory loss. This review provides a detailed framework for distinguishing transient global amnesia from its dangerous mimics and managing its course in the emergency department. In witnessed transient global amnesia with classic features, a minimalist approach is reasonable, avoiding overtesting, inappropriate medication, and medical interventions in favor of observation, ensuring patient safety, and reassuring patients and their families. Transient global amnesia confers no known long-term risks however, when abnormal signs or symptoms are present, they take precedence and guide the formliation of a differential diagnosis and investigation. The diagnosis is dependent on eliminating other more serious etiulogies including toxic ingestions, acute strokes, complex partial seizures, and central nervous system infections. Transient global amnesia is a clinically distinct syndrome characterized by the acute inability to form new memories. High-Risk Features In Patients With Suspected Transient Global Amnesia Diagnostic Features Of Transient Global Amnesia Risk Management Pitfalls For Transient Global AmnesiaĬlinical Pathway For Sudden And Persistent Amnesia (Once that symptom is confirmed, ruling out other possible causes of amnesia is important.Historical Features Of Transient Global Amnesia The main symptom of transient global amnesia is being unable to create new memories and remember the recent past. Transient global amnesia isn't serious, but it can still be frightening. During recovery, you may begin to remember events and circumstances. Episodes of transient global amnesia always get better slowly over a few hours. With transient global amnesia, you do remember who you are, and you recognize the people you know well. The condition most often affects people in middle or older age. You may also draw a blank when asked to remember things that happened a day, a month or even a year ago. You may keep repeating the same questions because you don't remember the answers you've just been given. You may not remember anything about what's happening right now. You can't remember where you are or how you got there. This confused state isn't caused by a more common neurological condition, such as epilepsy or stroke.ĭuring an episode of transient global amnesia, a person is unable to create new memory, so the memory of recent events disappears. Transient global amnesia is an episode of confusion that comes on suddenly in a person who is otherwise alert.
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