Transient global amnesia: Difference between revisions
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==Background== | ==Background== | ||
*Paroxysmal, transient | *Paroxysmal, transient anterograde amnesia lasting several hours <ref>D Owen et al. Classical diseases revisited: transient global amnesia. Postgrad Med J. 2007 Apr; 83(978): 236–239.</ref> | ||
*Most common in female 40-60yo<ref>Lin KH, et al. Migraine is associated with a higher risk of transient global amnesia: a nationwide cohort study. Eur J Neurol. 2014; 21(5):718-24.</ref> | *Most common in female 40-60yo<ref>Lin KH, et al. Migraine is associated with a higher risk of transient global amnesia: a nationwide cohort study. Eur J Neurol. 2014; 21(5):718-24.</ref> | ||
==Clinical Features== | ==Clinical Features== | ||
* | *Anterograde amnesia | ||
*Unaware of their memory loss | *Unaware of their memory loss | ||
*Normal attention and social skills | *Normal attention and social skills | ||
*Struggle with delayed recall | |||
*Periods of time typically less than 24 hrs, but typically lasts 4-6 hrs<ref>Zeman AZ, et al..Transient global amnesia. Br J Hosp Med. 1997; 58:257-60.</ref> | *Periods of time typically less than 24 hrs, but typically lasts 4-6 hrs<ref>Zeman AZ, et al..Transient global amnesia. Br J Hosp Med. 1997; 58:257-60.</ref> | ||
*No localizing symptoms | *No localizing symptoms | ||
**If localizing symptoms, consider alternative diagnosis | **If localizing symptoms, consider alternative diagnosis | ||
===Diagnostic Criteria=== | |||
*Attack must be witnessed. | |||
*Acute onset of anterograde amnesia | |||
*No alteration in consciousness. | |||
*No cognitive impairment other than amnesia. | |||
*No loss of personal identity. | |||
*No focal neurology or epileptic features . | |||
*No head trauma attributing amnesia to a [[concussion]] | |||
*Must resolve within 24 hours | |||
*No other causes of amnesia<ref>Hodges J R, Warlow C P. Syndromes of transient amnesia: towards a classification. A study of 153 cases. J Neurol Neurosurg Psychiatry 199053834–843. </ref> | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 15: | Line 27: | ||
*[[Hyponatremia]] | *[[Hyponatremia]] | ||
*[[Meningitis]]/[[encephalitis]] | *[[Meningitis]]/[[encephalitis]] | ||
*[[Seizure]] | |||
*[[CVA]] | |||
*[[Hyperosmotic Coma]] | *[[Hyperosmotic Coma]] | ||
*[[Drug toxicity]] | *[[Drug toxicity]] | ||
| Line 21: | Line 35: | ||
*Demyelinating disease ([[MS]]) | *Demyelinating disease ([[MS]]) | ||
*Conversion disorder | *Conversion disorder | ||
*Alcohol blackout | |||
==Workup== | ==Workup== | ||
| Line 35: | Line 50: | ||
#Also consider: | #Also consider: | ||
#*Pregnancy test | #*Pregnancy test | ||
#*CXR (if infection suspected) | #*[[CXR]] (if infection suspected) | ||
#* | #*[[Urinalysis]] (if infection suspected) | ||
#* | #*[[Urine toxicology screen]] (if ingestion suspected) | ||
==Management== | ==Management== | ||
Latest revision as of 05:14, 15 May 2022
Background
- Paroxysmal, transient anterograde amnesia lasting several hours [1]
- Most common in female 40-60yo[2]
Clinical Features
- Anterograde amnesia
- Unaware of their memory loss
- Normal attention and social skills
- Struggle with delayed recall
- Periods of time typically less than 24 hrs, but typically lasts 4-6 hrs[3]
- No localizing symptoms
- If localizing symptoms, consider alternative diagnosis
Diagnostic Criteria
- Attack must be witnessed.
- Acute onset of anterograde amnesia
- No alteration in consciousness.
- No cognitive impairment other than amnesia.
- No loss of personal identity.
- No focal neurology or epileptic features .
- No head trauma attributing amnesia to a concussion
- Must resolve within 24 hours
- No other causes of amnesia[4]
Differential Diagnosis
- Hypoglycemia
- Hyponatremia
- Meningitis/encephalitis
- Seizure
- CVA
- Hyperosmotic Coma
- Drug toxicity
- Lithium, phenytoin, carbamazepine
- Complicated migraine
- Demyelinating disease (MS)
- Conversion disorder
- Alcohol blackout
Workup
Depending on presentation, consider CVA workup
- Bedside glucose
- Bedside hemoglobin (polycythemia)
- CBC
- Chemistry
- Coags
- Troponin
- ECG (esp A-fib)
- Head CT
- Primarily used to exclude intracranial bleeding, abscess, tumor, other stroke mimics
- Also consider:
- Pregnancy test
- CXR (if infection suspected)
- Urinalysis (if infection suspected)
- Urine toxicology screen (if ingestion suspected)
Management
- Rule out CVA (clinically or with further workup)
- Neurology referral
- Once diagnosed, no specific treatment needed[5]
Disposition
- Discharge home with neurology follow up
- Consider admission for equivocal cases
Prognosis
- Full recovery with amnesia of event
- Annual recurrence rate was 4.7%[6]
See Also
External Links
References
- ↑ D Owen et al. Classical diseases revisited: transient global amnesia. Postgrad Med J. 2007 Apr; 83(978): 236–239.
- ↑ Lin KH, et al. Migraine is associated with a higher risk of transient global amnesia: a nationwide cohort study. Eur J Neurol. 2014; 21(5):718-24.
- ↑ Zeman AZ, et al..Transient global amnesia. Br J Hosp Med. 1997; 58:257-60.
- ↑ Hodges J R, Warlow C P. Syndromes of transient amnesia: towards a classification. A study of 153 cases. J Neurol Neurosurg Psychiatry 199053834–843.
- ↑ Owen D, et al. Classical diseases revisited: transient global amnesia. Postgrad Med J. 2007; 83(978):236–239.
- ↑ Hinge HH, et al. The prognosis of transient global amnesia. Results of a multicenter study. Arch Neurol. 1986; 43(7):673-6.