Even then, they further cited multiple prior cases with similar hippocampal involvement, albeit small variations in clinical presentation, such as in Carota et al. reported a clear case of TGA in 2016 with findings of DWI hyperintensity in the right hippocampus on MRI and stenosis of the right posterior cerebral artery on CT angiography. Stroke workup eventually showed no other abnormality and she was sent home on Plavix and Lipitor 80mg daily.Ĭurrently, cases of transient global amnesia with DWI findings has typically implicated the hippocampus. MRI of the brain, however, showed a small DWI signal abnormality at the left cingulate gyrus (see Figures 1 and 2). Her repeat neurological examination that morning remained non-focal. Family at bedside also confirmed that she appeared to be at her baseline. Her registration and recall returned to normal. She knew she had a complete lapse of memory and was concerned about developing dementia like her father. The last event she recalled from the day prior was leaving the bathroom and walking towards her living room, apparently before she started cooking. The next morning, patient was back to her baseline but still had no idea how she got to the hospital. She was admitted to the hospital for overnight observation. There was no evidence of acute infection. Further work-up for altered mental status was unremarkable, chemistry and CBC were negative, GFR 113, and random sugar was 97. Blood pressure was 117/71 and patient was afebrile throughout her hospital course. She had no idea how she got to the emergency room, but she is oriented to person and time. She scored 3/3 on registration but was unable to recall objects after a while. During her ER stay, she had a completely normal and non-focal neurologic examination. En route to the hospital as well as in the emergency room, she kept asking the very same question, “where am I?” and “how did I get here?” Someone will offer the answer only to be met with the same questions minutes later. However, she was not following conversations and did not recognize her own sister who dropped by for dinner. There was no precipitating seizure and no incontinence. She could walk, and she had no weakness of any kind. She remained generally oriented with no focal complaints, and there was no headache or pain. She appeared lost and seemed to have forgotten what she was doing. There was no reported loss of consciousness or altered level of consciousness, just noting that she was acting “strange.” She was cooking at the time and suddenly left the food unattended on the stove. Family described that the patient had a sudden change in her behavior just prior to admission. Her only past medical history is obesity, hyperlipidemia, and hyperthyroidism, for which she takes levothyroxine 75mcg and simvastatin 40mg. CaseĪ 60-year-old woman was initially brought to the emergency room by concerned family members. In doing so, we hope to provide more data to the medical community regarding both incidence and areas of involvement in ischemic TGA to better our understanding of this condition. Here, we report a case of TGA in downtown Los Angeles with findings in the left cingulate gyrus as seen on DWI, a much rarer occurrence. The hippocampus has typically been sited as the affected structure, as review of MRIs in retrospective cases of TGA has shown a predominance of DWI hyperintensities in that region. Another hypothesis is that TGA may be associated with ischemia, and while the evidence is sparse, multiple case reports have been written to explore this theory. Vascular processes, epilepsies, and migraines have been postulated as possible etiologies, yet the lack of prevalence of these disorders in cases of TGA as noted in prior studies suggests against them as causes. In the decades since it was first observed, its characteristics have been defined clearly, yet the cause remains elusive. It subsequently resolves within 24 hours, and there are no known long-term sequelae aside from a mild amnestic period in some patients. Transient global amnesia is a clinical phenomenon described as the sudden onset of acute amnesia (mostly anterograde, but retrograde is also frequently observed) with neither altered consciousness nor cognitive impairment. While the etiology of TGA remains controversial, in discussing this case and the current literature we hope to provide further data supporting the possibility of an underlying ischemic process, as well as help better illustrate the neurologic structures involved. Symptoms quickly resolved, and she was discharged home in stable condition. Her hospital work-up was overall unremarkable except for the presence of a diffusion weighted imaging (DWI) abnormality on MRI suggestive of acute infarction in the left cingulate gyrus. We discuss a patient who presented to our hospital with signs, symptoms, and clinical course consistent with transient global amnesia (TGA).
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