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Transient Global Amnesia: Emergency Department Evaluation And Management

August 2016

Abstract

Transient global amnesia is a clinically distinct syndrome characterized by the acute inability to form new memories. It can last up to 24 hours. 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 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. 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. This review provides a detailed framework for distinguishing transient global amnesia from its dangerous mimics and managing its course in the emergency department.

Key words: amnesia, transient global amnesia, amnestic event, declarative memory, explicit memory, anterograde amnesia, retrograde amnesia, decisional capacity, transient epileptic amnesia

Points:

  • Transient global amnesia (TGA) is a clinical syndrome defined by the acute onset of profound anterograde amnesia (the inability to form new memories) lasting up to 24 hours (mean duration of symptoms 4-6 hours) in the absence of other neurulogic deficits or changes in alertness and cognition.
  • Other diagnoses are not excluded if there was no witness to corroborate the onset of the attack.
  • Imaging, laboratory studies, lumbar puncture, and electroencephalogram are not indicated unless there is suspicion for another diagnosis due to associated symptoms (eg, neurulogical deficits, cardiac/gastrointestinal symptoms) or if the patient has TGA-specific high-risk features.

Pearls:

  • Diagnosis of TGA is made only after more dangerous causes are excluded. Beware of fatal mimics!
  • Patients with TGA do not have capacity to sign out AMA while actively amnestic.
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