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Guest Blogger: Frederick Strobl, MD: Transient Global Amnesia

14 Aug

“Where am I?” you ask the nurse on the locked psychiatry ward.

“You are in County General,” he replies.

“Where is that?”

“Downtown. You were found wandering inside a coffee shop, confused, and without identification.”

“I remember nothing since I left home this morning. My memory is just blank.”

“Your husband is on his way. I called him a few minutes ago after you were able to recall your name and phone number for me. He said you pulled your car out of the garage, ran into the tree in front of your house, left it there, and then drove his car to your clinic. He said he had a day off so he slept in and has been trying to reach you ever since he realized something was amiss, but you left your purse, briefcase and cell phone in your car. You went to work, went through mail, charts and dictated letters. Your secretary said you seemed a little different–she thought something was definitely wrong when your dictations didn’t make sense. She said you went out for lunch and never came back. By that time your husband had called your office and the police brought you here, confused from the coffee shop.”

Transient Global Amnesia or TGA is a condition I diagnose in patients 2-4 times per year. There are many causes, but often none is found. Almost all patients have a full recovery, but in a few, the condition will recur. My first case was essentially the one described above–an MD whose TGA was caused by an unusual medication reaction. In almost all cases, patients function somewhat normally but their judgment is impaired and they make no memories.

My second case was a man who also wound up in the locked ward. He had a continuous epileptic attack but was able to talk to me reasonably well.  He was confused, but fluent in speech. I went through my usual protocol of blood tests, an electroencephalogram (EEG), and brain scans. When I looked at the results of the EEG, I noticed that he was having continuous seizure activity, yet was not moving a muscle. I re-examined the patient to see if I had missed some shaking, eye twitching, or anything that might look epileptic, but I saw nothing abnormal.  I gave him a large intravenous dose of a seizure medication. The next morning, he was totally recovered. He recalled nothing of the day before or of my examining him twice.

Other causes of TGA may include a large number of factors including migraines and various chemical abnormalities, as well as stroke-like problems. There are other patients who simply have psychiatric problems or feign the condition after perpetrating certain criminal acts or hoping to get an edge in legal cases.

Overall, Transient Global Amnesia is a fascinating condition that demonstrates the complexities of the brain and our limited understanding of what is the organ of the human body that we understand the least. The brain is the last frontier of medicine.

Frederick (Fritz) Strobl, MD is a neurologist and a Director of the Minneapolis Clinic of Neurology, one of the largest private clinics in the world devoted entirely to neurology. His Dr. Jack Stevens series of medical thrillers includes Presidential Migraines and Greek Flu. His next book, Cyber Death, is due to be released in April 2012. Contact Fritz at Fritz@FritzStrobl.net or visit www.fritzstrobl.net.

 
11 Comments

Posted by on August 14, 2011 in Guest Blogger, Medical Issues

 

11 responses to “Guest Blogger: Frederick Strobl, MD: Transient Global Amnesia

  1. Sheila Lowe

    August 14, 2011 at 9:39 am

    As my new book is the story of a young woman with amnesia, this was of special interest to me. It’s a topic that has always fascinated me.

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  2. Brenda

    August 14, 2011 at 3:34 pm

    This is most interesting. Thanks for this.

    My dad did not remember the evening in the emergency room and what he had done there when I told him a bit later during a rare moment of clarity he had (since he had CJD). The EEG that night had shown constant electrical activity.

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    • Fritz Strobl MD

      August 15, 2011 at 11:53 am

      Seizures are a problem with CJD and other diseases. One of the causes of TGA. I was lucky I saw the patient during the seizure/TGA. Otherwise, if the seizure was a one-time event, we might never have known. He had what we call Subclinical Status Epilepticus. There are other names. It is why I always do EEGs on my “Alzheimers” patients!

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  3. Clare K. R. Miller

    August 14, 2011 at 7:13 pm

    Wow, that’s really very interesting! I’m especially fascinated by the fact that judgment *and* the forming of new memories are both impaired together. What must that say about the brain?

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    • Fritz Strobl MD

      August 15, 2011 at 11:58 am

      It is amazing what we can carry on, eg, Patient 1 drove her car (after a bit of problem with her husbands) successfully to the hospital AND was able to dictate medical reports (albeit impaired ones); these are both complex tasks. Yet no memory. There was no ulterior motive to the amnesia and she’s been fine ever since. I tell my patients it is like being able to have the computer running but can’t save work on hard drive.

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  4. ljsellers

    August 14, 2011 at 7:52 pm

    Agreed. Fascinating! Thanks for this post.

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    • Fritz Strobl MD

      August 15, 2011 at 11:58 am

      Thanks for reading it. And thanks to Dr. Lyle for having me as a guest blogger!

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  5. J.D.

    August 15, 2011 at 6:01 am

    2 t0 4 per year. I would’ve thought MORE rare. But you are a neurologist. Very interesting. The cover on Greek Flu looks like Santorini. That’s beautiful. Very interesting post.

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  6. Fritz Strobl MD

    August 15, 2011 at 12:06 pm

    The estimated rate is about 1 per 20,000 per year. So if one lives in a town of 100,000, that’s five cases each year. Minneapolis-St. Paul Metro area has about 3,300,000, so if my math is correct, that’s 165 cases per year.
    I took the pic in 2009 of Santorini and cruised on the boat pictured – they are superimposed. Then I had someone put in the vials. Greek Flu takes part largely in those Cyclade Islands. Thanks for the comment.

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  7. Sugel

    August 17, 2011 at 10:40 pm

    Both categories of amnesia can occur together in the same patient and commonly result from drug effects or damage to the brain regions most closely associated with the medial and especially the ..An example of mixed retrograde and anterograde amnesia may be a motorcyclist unable to recall driving his motorbike prior to his head injury retrograde amnesia nor can he recall the hospital ward where he is told he had conversations with family over the next two days anterograde amnesia ..The effects of amnesia can last long after the condition has passed. Some sufferers claim that their amnesia changes from a neurological condition to also being a psychological condition whereby they lose confidence and faith in their own memory and accounts of past events..Another effect of some forms of amnesia may be impaired ability to imagine future events.

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