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Typical questions include “How did I get to the hospital?” and asking medical staff, “Have we met?” despite several introductions. The classic TGA patient exhibits the “broken-record” phenomenon (asking the same questions repeatedly) in the absence of other signs or symptoms. In TGA, isolated loss of new memory formation is limited to facts and events (declarative memory), and patients retain implicit and procedural memory (motor tasks and coordination). Retrograde amnesia (the loss of pre-existing memories) can also occur. Transient global amnesia (TGA) is a clinical syndrome marked by the acute onset of profound anterograde amnesia (the inability to form new memories) lasting up to 24 hours in the absence of other neurologic deficits or changes in alertness and cognition. You wonder: Should you discharge this patient against medical advice? Introduction She consistently and accurately verbalizes, without reminders, several times over 30 minutes, the risks associated with leaving. I’d like to sign out against medical advice.” She is alert and oriented and lacks psychiatric risk factors. In the meantime, she has developed new mild ataxia. She has not repeated any questions during the past 2 hours and remembers your latest conversations. Twenty hours later, her amnesia has fully resolved. You place her on hospital involuntary hold. You explain to her repeatedly that, because she is not encoding memories, she cannot be discharged, and lacks decisional capacity. She states that she feels fine and wants to sign out against medical advice. She also complains of a mild diffuse headache, but she has no other symptoms and is found to be neurologically and, otherwise, cognitively normal. She demonstrates clear anterograde amnesia, failing to remember you on multiple occasions. In the ED, the patient is alert and oriented to self and place, but not to time. EMS providers detected no stroke symptoms and transported her to your ED. She was smoking a cigarette with her friend when she became confused and started asking, “How did we get here?” repeatedly. You wonder if you should activate the stroke team and order an emergent CT of the brain.Ī 54-year-old woman with hypertension presents with sudden memory loss. When you step away and subsequently return to the bedside a few minutes after the initial encounter, the patient does not recognize you and asks, “Have we met before?” The patient has no other complaints, and there are no neurologic or infectious symptoms. He is perseverating about what he was doing 1 hour ago. He knows what he did yesterday and this morning but cannot seem to recall events of the past few hours. The patient is calm, cooperative, and oriented to person, place, and time, but he frequently repeats himself and does not appear to be forming new memories. His wife has been with him since the onset of symptoms, when he started asking her the same question repeatedly every few minutes. Opening CasesĪ 60-year-old man with no significant medical history is brought to the ED by EMS after 2 hours of sudden memory loss. This review provides a detailed framework for distinguishing transient global amnesia from its dangerous mimics and managing its course in the emergency department.

In witnessed transient global amnesia with classic features, a minimalist approach is reasonable, avoiding overtesting, inappropriate medication, and medical interventions in favor of observation, ensuring patient safety, and reassuring patients and their families. Transient global amnesia confers no known long-term risks however, when abnormal signs or symptoms are present, they take precedence and guide the formliation of a differential diagnosis and investigation.

The diagnosis is dependent on eliminating other more serious etiulogies including toxic ingestions, acute strokes, complex partial seizures, and central nervous system infections. Transient global amnesia is a clinically distinct syndrome characterized by the acute inability to form new memories. High-Risk Features In Patients With Suspected Transient Global Amnesia Diagnostic Features Of Transient Global Amnesia