Transient global amnesia

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Transient global amnesia is an illness of uncertain aetiology. Some authorities feel it represents cerebrovascular disease, others attribute it to migraine and still others regard it as an epileptiform phenomenon [84]. Most would agree, however, that it is not an epileptic event. These stereotypic events are quite characteristic and easily recognized by the experienced clinician [85]. Amnesic episodes are recurrent in 8%.

The patient typically presents in a confused state, unsure of what they are doing or where they are going. Although they have little awareness of their current circumstances they typically retain personal information. The episodes can last up to hours, after which small islands of memory start to return of what went on during the amnestic period. However, some never recover any memory for the time that was involved. As a result these episodes typically cause great anxiety to those around them.

Although slightly perplexed or agitated during the attacks, no focal neurological abnormalities are found. EEGs and structural imaging are normal, and blood tests provide no clues. However, the description of events is so characteristic that the diagnosis is generally straightforward. Most patients have a history of migraine, and sometimes the episodes are followed by headache [86], Rare causes include lacunar stroke seizures. If the seizure was not recognized then the most striking feature of a seizure might be a postictal con-fusional state afterwards but it is generally global and lacks the peculiar specificity of the true transient global amnestic attack [87].

Patients with transient global amnesia need no further investigation and no other specific therapy besides strong reassurance.

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