The patient and their relative should be advised to seek medical help if the symptoms recur, as it is very uncommon for someone to suffer an episode of TGA more than once, and repeated episodes are suggestive of transient epileptic amnesia instead. Unlike with a TIA, patients who have had TGA are not at an increased risk of stroke. Many patients and relatives are anxious that the patient has suffered a stroke, but they can be reassured that this is not the case. Once a diagnosis of TGA has been made, reassurance is all that is required. Although these findings have intensified the debate surrounding the aetiology of TGA, they are not useful diagnostically and TGA remains a clinical diagnosis. It has been increasingly recognised that some patients who have had an episode of TGA have changes on diffusion-weighted brain MRI within 48 hours of symptom onset.
No recent history of head trauma or seizures.Cognitive impairment limited to amnesia.No change of consciousness or loss of self-awareness.The following diagnostic criteria for TGA are widely used: 2 A witness is required as the patient will not recall anything from the episode.Ī diagnosis of TGA can be made if there is an episode of sudden-onset anterograde amnesia lasting several hours, with repetitive questioning in the absence of any other impairment. Most patients only ever suffer one episode of TGA.ĭiagnosis is based entirely on the history. The episode should last less than 24 hours and in most cases will last only a few hours.Īfter the episode, the patient will return to normal but will have no memory of the period during the attack and may not recall the hours preceding symptom onset. Several triggers have been identified, such as sudden changes in temperature, emotional distress or a Valsalva manoeuvre (as in this case). The ability to perform complex tasks such as cooking and driving is preserved during an attack. During the episode, patients will typically ask the same questions repeatedly as they are unable to retain new information. TGA is characterised by sudden-onset, transient anterograde and retrograde amnesia. Proposed causes include migraine, venous flow abnormalities, focal ischaemia and epilepsy. It is relatively uncommon, with an incidence of 5-11 per 100,000 people per year. Transient global amnesia (TGA) is a benign amnestic syndrome, lasting less than 24 hours. She goes home without any further investigation but is advised to return if she has a further episode in the future. The GP reassures the patient that she has not had a stroke and that the episode was most likely to have been transient global amnesia. She scores 10/10 on an abbreviated mental test. Neurological examination of her cranial nerves and of her limbs is unremarkable.
Both the patient and her husband are concerned she may have had a stroke. She is now back to her normal self, but cannot recall anything that happened from the onset of the episode until it resolved. Her husband reports no speech disturbance or limb weakness during this time. This episode lasted for two hours before resolving gradually. He also says that at the time of the episode, she was unable to recall events from earlier that day. Her husband reports that she had asked the same questions repeatedly every five minutes. Her symptoms had started immediately after lifting a heavy box at home. A 68-year-old lady with a background of hypertension presents to her GP with sudden-onset memory loss that began earlier that day.
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