Introduction
Transient global amnesia (TGA) is a condition associated with temporary anterograde amnesia with or without retrograde amnesia, often resolving within 24 hours. It is mostly prevalent in elderly women with a mean age of 60-65 years and may be triggered by acute stressors like emotional trauma, strenuous exercise, Valsalva maneuver, sudden change in body temperature, intense pain, medical procedures, and sexual intercourse. We present a case of 62-year-old female who presented with transient global amnesia while having sexual intercourse.
Case presentation
62-year-old female with no significant past medical history presented after having an acute mental status change during sexual intercourse. The episode began with the patient turning her head, and having a staring spell that lasted for few seconds following which she was disoriented to place and was asking same questions repeatedly. The patient was repeatedly asking where she was and where her handbag was during the episode which lasted almost 2 hours during which she was brought to the hospital. Review of systems was negative for any focal weakness, sensory loss, headache, seizures. She denied having any prior episodes of memory loss, migraines, syncope, stroke like symptoms or psychiatric conditions. Social history was only significant for occasional alcohol use but denied tobacco or recreational drug use.
On the physical exam, the patient was alert, awake and oriented. Her cognition was intact. No focal neurological or cranial nerve deficits were noted. Lab workup was unremarkable except for slight hypokalemia. CT head without contrast and CT angiogram of head were unremarkable. The patient was diagnosed with TGA and was observed overnight with supportive care. MRI brain with and without contrast next day after the event only revealed tiny punctate area of susceptibility artifact within the right posterior parietal lobe. Patient and family were reassured and was discharged home.
Discussion
TGA is a condition accompanied by temporary anterograde amnesia with repetitive questioning. TGA has an incidence of 5.2 to 10 per 100,00 per year. Common risk factors include older age, migraines, and rarely familial causes. Most possibly related to neurological damage in median temporal lobe or hippocampus as these areas are strongly associated with memory formation. Potential etiologies include arterial ischemia, venous congestion and cortical spreading depression seen in migraine. TGA is a diagnosis of exclusion, only after ruling out other differential diagnosis like hypoglycemia, acute intoxication, transient ischemic attack, drug withdrawal and Wernicke's encephalopathy. Patients need to be admitted for observation until the amnesia resolves. Neuroimaging helps rule out serious pathologies and EEG may be considered in patients with high clinical suspicion for seizure. No specific intervention is required, and the patient and their families must be reassured that the condition is benign and usually does not recur.
| Identifer | oai:union.ndltd.org:ETSU/oai:dc.etsu.edu:asrf-2098 |
| Date | 25 April 2023 |
| Creators | Erpenwar, Sohan, sanku, koushik, vedantam, venkata |
| Publisher | Digital Commons @ East Tennessee State University |
| Source Sets | East Tennessee State University |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | Appalachian Student Research Forum |
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