Experience with a TGA?

[fever5]

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Yesterday (a few hours ago), my dad, presented with what the neurologist believes is a transient global amnesia event. He is 58, about 20-30 (?) pounds overweight, hypertensive, but controlled and treated for it, no family history of cardiovascular events. I am onlhy in Med I, and am slighlty neurotic with the neurologist's working diagnosis (although I am starting to believe it now, given normal neuro exam, lack of any findings otherwise)

Without getting into the details (he presented exactly as described by this eMed article http://www.emedicine.com/neuro/topic380.htm) I was wondefing if anyone has experience with a TGA's prognosis?

i am not in the hospital until the morning, but I just find it so strange that this kind of event can be transient when every 10 seconds he is asking the same questions (again the eMed article describes his behaviour to a T).

Thanks in advance for any input. If one does not know what a TGA is, I suggest looking at the above article. It seems really interesting, but I can only say that because the long term morbidity appears to be none, but ag ain, any input appreciated.

 

[fever5]

Well, as it turns out he is much better today. Slight memories problems, retrograde amnesia 12 hours prior to incedent. However functioning much better, and we expect him to be completely fine tommorow after some rest. He had an MRI with absolutely no findings. No sign of aetherosclerosis or any findings which may have suggested an obvious cerebrovascular event.

Wow. What an absurd occurance. We're just glad that its nothing permanent. Imagine the movie 50 first dates with a 30 second memory!

 

[nycdoc22]

Prognosis is usually excellent.
A Recurrence occurs in a about 25% of people. Less than 3% have more than 3 events in their lives. I'm a 4th year resident and have seen about 3 thusfar in an ER setting. It is very interesting [unless it occurs to a family member of course]/


Was he started on daily ASA? It is not absolutely indicated, but I'd probably start it in the abscence of any contraindications.

 

[fever5]

He's a radiologist who does lots of chest CT, thus he's all about keeping arteries clean. He has put himself on ASA for as long as I can remeber. (He's even tried to convince me to go on it, but I hold off for another 9 years or so) He was planning on putting himself on another blood thinner (forget which one), but after seeing how clean his carotids and other arteries were, he's decided against it for now.

 

[AznTrojan]

haha..

i just saw a patient with TGA a couple weeks ago..

apparently.. they are pretty common.. and patients usually return to baseline.. 👍

 

[Apollyon]

haha..

i just saw a patient with TGA a couple weeks ago..

apparently.. they are pretty common.. and patients usually return to baseline.. 👍

Pretty common? The incidence is 1:100,000 - I saw one when I was an intern in NYC where the ED volume was just under 100K, and 2 years later my aunt had it. Even if all the s/s were consistent with what eMed says, psychiatric fugue has to be considered. To see more than one is unlikely, and it's just random chance that I did.

Seeing 3 in one month in the ED (edit: I thought it was in one month) is either miraculous, or misdiagnosed.

 

[fever5]

Even if all the s/s were consistent with what eMed says, psychiatric fugue has to be considered.

Well besides the neurologist diagnosis of TGA, it was more than just s/s. Precipitating factors, duration of event, even type of memory loss was exactly as described by the diagnostic criteria of Caplan, Hodges and Warlow.

Psychiatric fugue, although I believe occured in his past according to what he had described as past dissociative incidents, this event was inconsistant with psychiatric fugue as he is absolutely no idea that he was unaware for that period of time. He also has no recollection of any of the events that occured during the time, which sometimes occurs in a fugue.

However I do agree that caution is always warrented, but everything I have read so far makes it a text book diagnosis of TGA.

When I first posted, I was just concerned that he had some obscure form of a TIA as I had no clue what a TGA was, and thought a TGA was almost too far out to be possible. I guess it was more for reassurance. Thanks to everyone who has responded.

 

[Bonobo]

The actual incidence of TGA may be 1:10,000 if one uses prospective studies rather than retrospective ones where incidence is classically underestimated. If one considers that the average hospital in a major city has a cachement of 100,000 people, that means about 10 cases of TGA a year per hospital. TGA may seem less uncommon however because only a few of these cases will reach the hospital neurologist, but based on these stats alone, it is not unreasonable to think that the average neurology resident should see a few cases of TGA during their residency (especially in major academic institutions). Of course, these stats are very rough and TGA may well be more or less common than this.

The etiology is very controversial and interesting ranging from TIA-like mechanisms to migraine and miniature seizures. I am willing to bet on a venous-related issue, given vascular anatomy of the hippocampus and the amygdala, but that is really just a wild guess.

B

 

[AznTrojan]

must be a good month here at JMH.. i've been in the ER the past 4 weeks.. and we had 2 TGA patients.. 😀

i saw one of them.. and he basically forgot everything over a 12 hour period.. it was kinda funny.. because i would check up on him every hour or so.. and he didn't remember who i was.. although.. the next day.. he was fine 😀

 

[neigeflake]

I, too have seen several cases of TGA this year. We see quite a few cases each year and it is not nearly as unusual a diagnosis as some may think. Interestingly some of the newer research show DWI abnormalities do occur in the temporal lobe/hippocampus region. These can occur 24-48 hours after the event and thus a normal initial MRI is not unusual.

it's definately a most interesting syndrome...the best part is that the patient gets better so quickly