If a patient can remember the period of "memory loss" after the fact, does that rule out transient global amnesia? We have a gentleman who woke up feeling fine, developed a headache and progressive "memory loss," and drove himself to the hospital. He could barely remember why he came to the hospital, was oriented to only person, and demonstrated poor recall and attention. By the next day, he could recall the events of the day prior, including being asked specific questions and being unable to answer them. Does this rule out TGA? Our team is debating whether the fact that he was clearly forming enough new memories to remember the event is inconsistent with TGA, while the rest of the story sounds a lot like it (the alternative being more of an aphasia with word finding difficulties...although he was also unable to, for example, select the date from multiple choices). Your input is appreciated! (MRI w/o any acute findings by the way)
Transient Global Amnesia - With post-event recall?
- Thread starter Xinlitik
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Yes, that rules out TGA. The headache and poor attention are also atypical. The TGA presentation is classic with the person repeating the same questions over and over on a 4-6 minute cycle, just as things clear from working memory and fail to enter short term memory. Once you've seen one they all look the same.
You noted:
Our team is debating whether the fact that he was clearly forming enough new memories to remember the event is inconsistent with TGA, while the rest of the story sounds a lot like it (the alternative being more of an aphasia with word finding difficulties...although he was also unable to, for example, select the date from multiple choices).... (MRI w/o any acute findings by the way)...
I agree w/AS1 that it wasn't TGA, but what was it? Could have been a TIA in some distribution affecting language but not memory registration/storage. How about a migraine? It also could not have been a generalized or complex partial seizure, but might have been some form of partial seizure with "psychic" features but recall of the ictal events. If so that would be pretty rare and reportable if you could prove it. Another possibility is some sort of psych d/o (e.g. dissocitive reaction).
Our team is debating whether the fact that he was clearly forming enough new memories to remember the event is inconsistent with TGA, while the rest of the story sounds a lot like it (the alternative being more of an aphasia with word finding difficulties...although he was also unable to, for example, select the date from multiple choices).... (MRI w/o any acute findings by the way)...
I agree w/AS1 that it wasn't TGA, but what was it? Could have been a TIA in some distribution affecting language but not memory registration/storage. How about a migraine? It also could not have been a generalized or complex partial seizure, but might have been some form of partial seizure with "psychic" features but recall of the ictal events. If so that would be pretty rare and reportable if you could prove it. Another possibility is some sort of psych d/o (e.g. dissocitive reaction).
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I agree with the differential given above. My vote is migraine, but it is easy to lay your nickel down when you haven't seen the patient. 😉
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