Transient Global Amnesia

 

Am Fam Physician. 2022 Jan ;105(1):50-54.

Author disclosure: No relevant financial relationships.

Transient global amnesia (TGA) is a clinical syndrome characterized by anterograde amnesia, mild retrograde amnesia, and confusion up to 24 hours. Most commonly seen in patients older than 50 years, TGA results from the temporary impairment of short-term memory formation. Clinically, patients have time disorientation and often ask repeated questions regarding the day's events. Vomiting, headache, blurry vision, dizziness, and nausea may be present. A physically or psychologically stressful precipitating event, such as emotional stress, significant physical exertion, exposure to extreme temperatures, high-altitude conditions, Valsalva maneuver, acute illness, or sexual intercourse, is often the cause. The pathophysiology of TGA is not well understood but may be related to impaired venous drainage of the hippocampus. The diagnosis is primarily clinical, but recent studies suggest that magnetic resonance imaging may be helpful. TGA is self-limited and resolves within 24 hours. There is no established treatment for episodes. The lifetime recurrence rate is 2.9% to 23.8%. Recent evidence suggests an association between TGA and migraine headaches as well as takotsubo cardiomyopathy. No apparent increased risk of cerebrovascular events occurs in patients who have had an episode of TGA. There is conflicting evidence as to whether an episode of TGA predisposes to future seizures or dementia.

Transient global amnesia (TGA) is characterized by the sudden onset of transient, anterograde amnesia without further focal neurologic deficits.16 Mental status is overall normal but may include mild confusion.1,2 Research suggests that the diagnosis is missed 90% of the time at initial presentation, often resulting in extensive and perhaps unnecessary evaluations.3

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingComments

TGA should be considered in a patient with less than six hours of amnesia, no focal neurologic findings, and diffusion-weighted magnetic resonance imaging with hippocampal bright lesions.1,6

C

Expert opinion and case studies

Any amnesic episode lasting longer than 24 hours is unlikely to be TGA and warrants additional evaluation.1

C

Definition, expert opinion, and many case studies

If the diagnosis of TGA is certain, only supportive treatment is indicated.6

C

Case studies


TGA = transient global amnesia.

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingComments

TGA should be considered in a patient with less than six hours of amnesia, no focal neurologic findings, and diffusion-weighted magnetic resonance imaging with hippocampal bright lesions.1,6

C

Expert opinion and case studies

Any amnesic episode lasting longer than 24 hours is unlikely to be TGA and warrants additional evaluation.1

C

Definition, expert opinion, and many case studies

If the diagnosis of TGA is certain, only supportive treatment is indicated.6

C

Case studies


TGA = transient global amnesia.

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

Epidemiology

The incidence of TGA is three to eight cases per 100,000 person years but increases to 23.8 cases per 100,000 in patients older than 50 years.2,46 A TGA episode is often preceded by a recent stressful physical or psychological event, with reports in the literature ranging from 52% to 89%.47 The most frequently cited precipitating events include acute illness, medical procedures, significant physical exertion, sexual intercourse, high-altitude environment, extreme temperatures, and Valsalva maneuver. 57 Triggering emotional events can be positive or negative; TGA has been associated with birth announcements, news of suicide, and in patients learning of worsening health troubles, family concerns, financial pressures, and higher-stress urban living situations.2,68

A history of migraine headache is the only diagnosis definitively associated with TGA, with a relative risk of 5.98.9,10 This is most prevalent among women 40 to 60 years of age.9,10 Other recent data suggest a higher rate of TGA in patients with hypertension and hyperlipidemia.11 Case reports of takotsubo cardiomyopathy happening concurrently with TGA have occurred,

The Authors

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DAVID SEALY, MD, FAAFP, FAMSSM, is founder and faculty of the Self Regional Healthcare Primary Care Sports Medicine Fellowship and a professor in the Department of Family Medicine at the Medical University of South Carolina, Greenwood....

ROBERT J. TILLER, MD, FAAFP, is director of the Self Regional Healthcare Family Medicine Residency Program and an associate professor in the Department of Family Medicine at the Medical University of South Carolina.

KATHERINE JOHNSON, MD, is a faculty member at the Self Regional Healthcare Family Medicine Residency Program and an assistant professor in the Department of Family Medicine at the Medical University of South Carolina.

Address correspondence to David Sealy, MD, FAAFP, FAMSSM, Self Regional Healthcare, 155 Academy Ave., Greenwood, SC 29646 (email: dsealy@selfregional.org). Reprints are not available from the authors.

Author disclosure: No relevant financial relationships.

References

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