Transient global amnesia: Minor inconvenience or early warning sign?

[A case of transient global amnesia associated with painless myocardial infarction]

A 66-year-old woman with a history of hypertension complained about sudden short-term memory loss. On arrival to our outpatient clinic, she was alert and oriented and did not have chest pain or shortness of breath. Neurological and neuropsychological examinations were within normal limits. In light of a transient anterograde amnestic attack and no neurological focal deficit, we clinically diagnosed transient global amnesia (TGA). To confirm whether there was an intracranial lesion or not, diffusion-weighted MRI of the brain was performed, and revealed hyper-intense lesions in the left hippocampus and right corpus callosum. Consequently, the patient was admitted to our hospital on follow-up for suspected cerebral infarction. On day 1, laboratory tests indicated an elevated troponin I level, and electrocardiogram revealed an inverted T wave in the inferior leads. Coronary angiography on day 9 of admission demonstrated severe stenosis of the right coronary artery, leading to a diagnosis of non-ST elevation myocardial infarction. Although TGA itself typically has a favorable prognosis, clinicians should consider potential concurrent painless myocardial infarction in patients with TGA.

Anterograde Amnesia as a Manifestation of Acute Type A Aortic Dissection

Objectives  Memory impairment has been only rarely reported in association with acute aortic dissection type A. We report a patient with pure anterograde amnesia and memory impairment of contents occurring after the event, accompanying acute aortic dissection type A. Case Report  A previously healthy 53-year-old Caucasian male was admitted because of sudden chest pain after having lifted a heavy object. Clinical examination and electrocardiogram showed no abnormalities. Since blood tests showed leukocytosis, anemia, and elevated D-dimer level, either pulmonary embolism or aortic dissection was suspected; therefore, computed tomography was suggested. The patient seemed disoriented to time, and neurologic investigation confirmed that the patient was disoriented to time; short time memory was severely impaired and concentration was reduced. An amnestic episode with anterograde amnesia was diagnosed. Computed tomography showed type A aortic dissection. A supracoronary replacement of the ascending aorta was performed. The patient was discharged on the 7th postoperative day. Three months postoperatively, the patient is clinically stable; however, amnesia for the interval between pain onset and cardiac surgery persists. Conclusions  Transient amnesia, usually considered a benign syndrome, may be more common than generally recognized in aortic dissection. The suspicion for aortic dissection or other cardiovascular emergencies is substantiated when amnesia is associated with sudden onset of chest pain, leukocytosis, and elevated D-dimer levels. Computed tomography of the aorta with contrast medium is the imaging method of choice to confirm or exclude the diagnosis.