She was placed on a medication of aspirin for preventive purpose and remained asymptomatic at 12 months follow-up.įigure 1: Axial diffusion-weighted MRI showing hippocampal ischemic lesions in all three patients. Thus, she was clinically diagnosed with TGA. DWI of the brain revealed a tiny lesion with high signal intensity in the left medial hippocampus ( Figure 1A). The neurological examination and routine blood laboratory findings were normal, and her Mini-Mental Status Examination (MMSE) score was 29. The next day, she was referred to our department and examined via brain imaging.
Five hours later, her memory slowly returned to normal, except for her memory of the first 2 hours of the episode (from the beginning of endoscopy to arriving home). She repetitively inquired, “Where is here?” or “Who would take me home?” She had no difficulty recognizing her relatives. After the endoscopy, she experienced retrograde amnesia as well as anterograde amnesia, and the symptoms were observed by her relatives and the medical staff in internal medicine. I analyzed the clinical features and the neuro-radiological findings of three cases of TGA after GI endoscopy without prior medication.Ī previously healthy 66-year-old woman visited our hospital for a general medical examination and underwent an upper GI endoscopy without prior medication that demonstrated she had antral mucosal hyperemia.
All three previously healthy patients were confirmed to have tiny ischemic unilateral or bilateral lesions in their hippocampus on diffusionweighted imaging (DWI) of the brain. In this report, I describe two cases of TGA after GI endoscopy without prior medication except for oral lidocaine spray and one case of TGA after colonoscopy without prior medication. However, in these case reports, most patients had normal brain imaging results, and medical procedures alone could not be considered the main cause of TGA due to the use of prior medications or previous medical conditions. Moreover, relatively rare conditions associated with TGA have been reported, including prolonged and abnormal head posture, sudden immersion in cold or hot water, severe pain and some medical procedures, such as angiography and gastrointestinal (GI) endoscopy. Some cases reports have stated that amnestic symptoms are often precipitated by not only "Valsalva-like" physical activity, such as heavy lifting, sexual intercourse, coughing or swimming, but also psychological trauma or emotional stress. TGA is usually related to strenuous physical activity and severe emotional stress. Recent high-resolution neuroimaging data have suggested that memory circuits in the mesial temporal region are involved because hyperintense MRI lesions have been detected in the hippocampal formations of TGA patients. Some pathophysiological mechanisms have been proposed, including brain focal ischemia, migraine, venous flow abnormalities, epileptic phenomena and psychological disturbances. The diagnosis of TGA is established based on its clinical features, and typically, a discrete episode of anterograde amnesia is accompanied by repetitive questioning and resolution of the symptoms within 24 hours. Transient global amnesia (TGA) is a clinically amnestic syndrome characterized by sudden-onset, reversible anterograde amnesia during the episode without alterations in level of consciousness and focal neurologic deficits. Transient Global Amnesia (TGA) Gastrointestinal (GI) endoscopy Colonoscopy Tiny ischemic lesion Hippocampus
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