A 54-year-old woman with a history of depression, migraine headaches, and fibromyalgia is evaluated at the office at the request of her husband. The couple was returning home from an extended weekend vacation when the patient began behaving strangely. Her husband says she could remember details about herself and their family, but continually asked where they were going even after being told several times. She was anxious and was able to talk and answer questions appropriately. However, she could not remember any new information that she was told during this roughly 8-hour episode. Throughout the event, her husband saw no changes in the patient's ability to walk, write, or speak. He said that the following day she seemed to be back to normal although she did not recall what had happened. The patient has no dizziness, visual difficulties, chest pain, or other concerns.
The patient underwent endoscopy the previous week and was diagnosed with gastroesophageal reflux disease. She is now receiving treatment with a proton pump inhibitor but otherwise has had no recent changes to her medications, which include sertraline and ibuprofen.
Physical examination is unremarkable.
This patient's presentation is most likely a result of which of the following?

Question

A 54-year-old woman with a history of depression, migraine headaches, and fibromyalgia is evaluated at the office at the request of her husband.  The couple was returning home from an extended weekend vacation when the patient began behaving strangely.  Her husband says she could remember details about herself and their family, but continually asked where they were going even after being told several times.  She was anxious and was able to talk and answer questions appropriately.  However, she could not remember any new information that she was told during this roughly 8-hour episode.  Throughout the event, her husband saw no changes in the patient's ability to walk, write, or speak.  He said that the following day she seemed to be back to normal although she did not recall what had happened.  The patient has no dizziness, visual difficulties, chest pain, or other concerns.
The patient underwent endoscopy the previous week and was diagnosed with gastroesophageal reflux disease.  She is now receiving treatment with a proton pump inhibitor but otherwise has had no recent changes to her medications, which include sertraline and ibuprofen.
Physical examination is unremarkable.
This patient's presentation is most likely a result of which of the following?

Quizplus · Accepted Answer

The patient's presentation is consistent with transient global amnesia (TGA), a condition in which transient loss of memory for recent events and difficulty retaining new information occur (anterograde amnesia). Patients are disoriented to place or time, become anxious or upset, and may repeatedly ask questions such as where they are and why they are there. However, self-awareness, language, and motor and social skills are preserved, and neurologic examination is normal. The episode lasts for less than 24 hours (usually 1-10 hours) and may be precipitated by exertion, stress, changes in body temperature, Valsalva maneuver, or recent procedures. The pathophysiology of this condition is unclear. A history of migraines and age >50 are risk factors. Initial evaluation and management should focus on excluding other diagnoses (eg, toxic/metabolic encephalopathy, stroke, seizures). TGA usually does not recur, and treatment or driving restriction is not required. (Choices A and E) Transient ischemic attacks (TIAs) and seizure activity are the main differential diagnostic considerations for patients with TGA. In this patient, however, there are no accompanying symptoms such as speech or motor deficits that are suggestive of TIA and no automatisms such as chewing, lip smacking, or staring that characterize complex partial seizures. (Choices B and C) Depersonalization-derealization disorder is marked by the experience of detachment from oneself or one's surroundings rather than memory loss. Dissociative amnesia presents as loss of autobiographical memory. This patient was able to remember details about herself and her family during the episode. Educational objective: Transient global amnesia is characterized by a transient episode of impairment in anterograde memory. Patients are disoriented to place or time, but self-awareness and motor and social skills are preserved. The differential diagnoses include toxic/metabolic encephalopathy, stroke, and seizures, which must be ruled out. __________ References: Transient global amnesia: a case report. (http://www.ncbi.nlm.nih.gov/pubmed/22949910) Transient global amnesia: functional anatomy and clinical implications. (http://www.ncbi.nlm.nih.gov/pubmed/20129169)

A 54-Year-Old Woman with a History of Depression, Migraine Headaches