No abnormalities were found in the blood results. Blood work, which included a complete blood count, comprehensive metabolic panel, and troponin I, was ordered to rule out metabolic abnormalities, infectious etiologies, and myocardial infarction (see Tables Tables4 4- -6). A urinary analysis was ordered to assess for an asymptomatic urinary tract infection because these sometimes cause delirium in older females (see Table Table3). The attending physician ordered a non-contrast computed tomography (NCCT) of the head to rule out stroke, which was negative. Her National Institutes of Health (NIH) stroke scale was 2 at the time of admission due to incorrect responses given for the current month and patient age (see Table Table2). A physical examination revealed a blood pressure of 232/98 mmHg (see Table Table1). On admission, she was oriented only to self. The patient’s husband denied any significant medical, surgical, social, or family history. The patient’s husband was the primary historian for the patient, and the husband denied any trauma or additional associated symptoms. If TGA is a benign condition, research should additionally focus on distinguishing it from other conditions.Ī 70-year-old previously healthy female presented to a free-standing emergency room (ER) for a stroke alert with an approximately two-hour history of confusion. TGA often presents similar to various conditions, including stroke, hypertensive encephalopathy, seizure, and migraine. A crucial step in the evaluation of a patient is differentiating between diseases that need management and those that do not. Often there is overlap between many different disease processes. Patients often present with various symptoms. It is vital that research focuses on identifying the underlying cause of TGA and determining if further management is warranted. Emerging evidence has suggested shared pathophysiology with stroke. Once serious pathologies are ruled out, patients can be observed until they return to baseline. TGA is historically considered a benign condition. One facet of the underlying disease process is that the areas in the brain affected include the mediobasal temporal lobe and the hippocampus. If TGA is due to underlying ischemia, it is possible that it may have some relation to ischemic stroke. However, evidence from the Korean National Health Insurance Service has shown increased rates of transient ischemic attack (TIA) in those with a history of TGA, which could suggest an arterial ischemia model. The vascular congestion hypothesis is considered the strongest theory due to the frequency of preceding Valsalva. There is a wide variety of literature with conflicting opinions. Suggested theories include vascular congestion, arterial ischemia, migraine, or an underlying psychosomatic disorder. The underlying pathophysiology of TGA is not well understood. Associated symptoms are common and often include nausea, vomiting, and headache. Patients typically only have one event in their lifetime. These events include both physical stimuli, such as cold water or Valsalva, and emotional stimuli. Transient global amnesia (TGA) is a rare self-limiting syndrome that is defined as anterograde memory loss that resolves within 24 hours without any long-term damage. Approximately 30-90% of TGA patients report an event that precedes memory loss. It is also not clear if TGA is truly benign or has an association with stroke. Future research should focus on how to accurately identify or rule out serious diseases leading to a reduction in adverse events and patient costs. This scenario showcases how physicians have to balance the risk of serious diseases with the need for further testing. The patient was discharged after more serious pathologies were excluded after an extensive workup. The patient was evaluated by a neurologist and transferred to the hospital. Here, we present the case of a 70-year-old female who was admitted to a free-standing emergency room with confusion, memory loss, and hypertensive crisis that was diagnosed as TGA. Additionally, there is data that challenge the historical view that TGA is a benign condition requiring no long-term management. There is a debate with respect to what is sufficient for ruling out more serious pathologies. It shares multiple characteristics with a transient ischemic attack and ischemic stroke, which carry a more ominous outlook. Transient global amnesia (TGA) is a rare self-limited syndrome characterized primarily by anterograde amnesia.
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