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Dissociative amnesia after general anesthesia--a case report.

Psychogenic unconsciousness is a rare cause of failure of prompt recovery from general anesthesia. The diagnosis is only made by exclusion of other conditions. We describe a young, healthy female who failed to wake up promptly after total intravenous anesthesia with alfentanil and propofol. She regained consciousness 24 hours later without any specific treatment. However she sustained amnesia for a period of 48 hours. Dissociative disorder was diagnosed after an extensive workup. This case report emphasizes the importance of inclusion of psychiatric disorder in the differential diagnosis should unexplainable delayed emergence from general anesthesia occur.

Adult↗

Contrast study on cognitive function with MRI and positron emission tomography imaging in transient global amnesia.

OBJECTIVE: To study cognitive function and cerebral metabolic changes in patients with transient global amnesia (TGA). METHODS: Three patients with TGA were given mini-mental state examination (MMSE), revised Wechsler memory scale (WMS-R) examination and magnetic resonance imaging (MRI) scans after they had been diagnosed as TGA. Using (18)F labelled deoxyglucose as tracer, patients were given a positron emission tomography (PET) examination at different periods during recovery. RESULTS: No obvious abnormality was found in MMSE and MRI scans in the three patients. However, WMS-R examination and cerebral PET imaging displayed cognitive dysfunction of varying degrees and low metabolism in local areas related to memory in 2 of 3 patients. CONCLUSIONS: In TGA patients, cognitive function and cerebral metabolic levels are closely correlated with duration of symptoms. It is necessary to stop the TGA attack as quickly as possible early time.

Aged↗

[Effect of haloperidol on development of amnesia in aggressive and submissive mice].

The effect of haloperidol on the passive avoidance habit retrieval upon amnesia was studied in C57BL/6J mice with aggressive and submissive behavioral stereotypes formed under agonist confrontation conditions. In the control (untreated) group, the efficacy of the amnesic action of detention in the dangerous compartment on the learning day was reduced for the aggressive stereotype as compared to the submissive one. In the aggressive mice, the administration of haloperidol (0.5 mg/kg) one hour before learning deteriorated the conditional reaction retrieval between 2nd and 13th days of test. In the submissive mice, the administration of haloperidol produced a prolonged antiamnesic effect. Thus, the effect of haloperidol on the violated memory trace reproduction depends on the individual behavioral state.

Aggression↗

[A case of transient global amnesia (TGA) showing bilateral hippocampal hypoperfusion by a new SPECT analyzing system, eZIS].

We here reported a case of typical transient global amnesia (TGA). A 64-year-old right-handed man was suddenly unable to keep his recent memory without any event. There were no neurological deficits except for recent memory disturbances. He showed no causative findings of the attack on examinations of laboratory data, EEG and MRI. Examination of single photon emission CT (SPECT), using 99mTc-ECD, was performed in acute and chronic stages. We were able to detect bilateral hippocampal hypoperfusion in the acute stage using a new analyzing system, easy Z-score Imaging System (eZIS). It showed extensive hypoperfusion also in the vertebrobasilar artery territory. Twenty-seven days later, these findings disappeared. Using this system, we are able to evaluate cerebral blood flow objective with anatomical information by SPECT. Therefore, we concluded that this analyzing system would be helpful to reveal the pathophysiological mechanism of TGA.

Amnesia, Transient Global↗

[Amnesia, confabulation and nonaphasic misnaming after left thalamic infarct].

A 72-year-old right handed woman developed amnesia, confabulation and abnormal (bizarre) verbal response after the left thalamic infarction. Clinical features including disorientation, euphoria and various kinds of paraphasia coincided in nonaphasic misnaming. MR images showed that lesions involved the genu of the internal capsule, the anteroventral nucleus, the lateroventral nucleus, intralaminar nuclei, the mamillothalamic tract and the region around the ventral thalamus. 99mTc-HMPAO-SPECT revealed decreased uptake in the left frontal lobe, probably due to the disconnection from the thalamus. These findings suggest that the dysfunction of the thalamus (mainly ventrolateral) and the left frontal lobe caused the disturbance of the self-monitoring in the language use, which generated confabulation and nonaphasic misnaming in our case.

Aged↗

[A case of cerebral infarction presenting as retrosplenial amnesia].

We report a 73-year-old right-handed female who presented with an acute amnesic syndrome. On November 18, 1991, she was admitted to a local hospital complaining of sudden-onset vertigo and nausea, but immediately after the admission she developed an amnesic syndrome. On November 27, she was transferred to our hospital for further assessment of her memory disturbance. Neurologically she was normal except for mild right hemianopsia and increased deep tendon reflexes in the extremities. Neuropsychological assessments were performed over 3 weeks. She was always alert, attentive, and cooperative. She had no confabulation. On the Wechsler Adult Intelligence Scale revised (WAIS-R), her total IQ was 110. Frontal, verbal, and perceptual functions and motor performance were normal. She had no signs of a callosal disconnection. Despite these preserved functions, her memory function was obviously disturbed. Several memory betteries showed that her recent memory for both verbal and visual modalities was impaired, while her immediate memory such as digit span was preserved. For remote memory her retrograde episodic memory concerning both personal and public events was almost intact, although she had a profound anterograde amnesia. In particular she recalled her personal information about just-premorbid events in detail. On the other hand, her semantic memory, for example understanding of proverbs, geography, and scientific law, was preserved. Taken together, her procedural memory on learning tasks, such as "Tower of Hanoi" and mirror drawing, was intact. Computed tomography demonstrated a low-density area medial to the trigon of the left ventricle.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

Isolated amnesia following a bilateral paramedian thalamic infarct. Possible etiologic role of a whiplash injury.

A previously healthy 45 years old carpenter suffered a whiplash injury in a road accident on July, 18th, 1990. He continued to work in spite of occipital headache, episodic sweatening and slight hypersomnia. On August, 8th, 1990 while parking his car into the deck of a ferry-boat he was found slightly confuse and markedly amnestic. A post-traumatic subdural haematoma was suspected. As a CT-scan of the brain was normal, a toxic encephalopathy or an hysterical amnesia were proposed. However, a MRI performed on August, 22th, 1990, apart from a small infarct in the white matter of the left occipital lobe, showed two small bilateral paramedian thalamic infarcts. The last lesions usually follow a thrombotic or embolic occlusion of the "basilar communicating artery" (BCA) belonging to the vertebro-basilar system. The possible etiologic relationship between this syndrome and the previous whiplash injury has been considered. Six months later, while a control MRI showed a reduction of the brain lesions, a neuropsychological examination revealed a slight improvement of memory dysfunction evident also at a distance of further 6 months. This case is interesting because it tests the high sensitivity of MRI in amnestic syndromes and because of the possible role of a whiplash injury in the etiology of BPTI.

Amnesia↗

[Extinction and amnesia in aggressive and submissive mice with various terms of agonistic interaction].

Dependence of the passive avoidance retrieval on the duration of agonistic interactions was analyzed in C57BL/6J mice in procedures of extinction and amnesia during formation of aggressive and submissive behavioral stereotypes. The resistance to amnestic stimulation was lower in aggressive mice with 10-day experience of victories than in aggressive animals after 20 daily confrontations. Prolongation of extinction in aggressive mice and fast extinction in submissive animals did not depend on the number of agonistic interactions.

Aggression↗

[Bipolar head injury with global amnesia].

We report the first case of bipolar head injury, that is, subsequent head injuries sustained near both poles of the Earth. The injury caused a true global amnesia with loss of memory for the journey around the globe. This case history illustrates how modern emergency services have reduced the hazards of polar exploration, and how a second impact after a primary head injury may cause life-threatening complications.

Adult↗

Delayed amnesia and disorientation after electroconvulsive treatment.

Memory-related effects of electroconvulsive therapy (ECT) are known to appear immediately after the treatment. The case of a 39-year-old woman who underwent a course of ECT because of a recurrent major depressive disorder is described. After a symptom-free period of 48 hours, transient amnesia developed. Her condition appeared to be associated with the electroconvulsive therapy, thereby raising questions about its pathogenicity and management.

Adult↗

[A case of incest with dissociative amnesia and post traumatic stress disorder].

Incest is a kind of sexual abuse that causes serious disorders during childhood and adulthood. In order to overcome the trauma, abuse victims frequently use dissociative defence mechanisms. Post traumatic stress disorder, dissociative disorders, major depression and borderline personality disorder can be seen in the victims of childhood sexual abuse. In this article we present an adolescent who was found and brought to our clinic by the Children's Police Department while she was wandering around aimlessly. She could not remember anything about her identity or personal history. She had no apparent physical disturbances, marks of beating or wounds which could be seen externally. Her physical and neurological examinations were both normal. In her laboratory tests, there was nothing abnormal. No sign of intoxication or infection was detected. EEG and CT were also normal. After the family was found, we learned about the sexual and physical abuse and the patient was diagnosed with dissociative amnesia. The psychometric evaluations also supported our diagnosis. When the dissociation began to disappear, post traumatic stress disorder symptoms became more apparent. After she described her traumatic memories, PTSD symptoms began to recede. Through this case presentation we would like to emphasize the relationship between childhood physical and sexual abuse and dissociative disorders.

Adolescent↗

[Does brain blood flow HMPAO SPECT withhold the vascular etiopathogenic theory of transient global amnesia?].

INTRODUCTION: Transient global amnesia (TGA) is a neurological disorder that consists in a sudden loss of anterograd memory and temporospatial disorientation during less than 24 hours. Several precipitating factors have been reported. Conventional neuroimaging scans usually are negative. Different etiopathogenic theories have been postulated but the vascular etiology is the most commonly accepted. CASE REPORTS: Three patients with a typical presentation of TGA are studied. In all of them two brain blood flow HMPAO SPECT were performed, within the first 48 hours from the onset and three months after as an evolutive control. The first patient showed a left temporal perfusion defect and temporoparietal hypoperfusion. The second showed frontotemporal hypoperfusion, temporal mesial defect and hypoperfusion in basal ganglia, all in the left side. The third patient showed thalamic hyperperfusion and cerebellum hypoperfusion, both in the left. In all of them, control SPECT normalized. CONCLUSION: Three etiopatogenic theories about TGA have been reported: epilepsy, migraine and blood flow impairment. In TGA neuroanatomic image and neurophysiologic studies usually do not show significative alterations. Conversely, functional studies as brain blood flow HMPAO SPECT, do show changes being the most common bilateral temporobasal hypoperfusion, although this is not the only pattern described. Causes of this variable behaviour remain unclear but can be related to different clinic expressions and, over all, to time of evolution from onset. The three cases in this study show three different perfusion patterns reported in TGA and all of them withhold the vascular etiopathogenic theory.

Adult↗

[Clinical symptoms, pathopsychological peculiarities and mechanisms of biographic amnesia].

Clinical and pathopsychological analysis of 16 men, aged 15-53 years, was carried out. In premorbid stage, hysterical, hystero-epileptoid, schizoid, emotional-unstable features were found in 12 patients and personality accentuation--in 4 patients. There were the absence of marked cognitive disturbances and safety operational functions of intellect, i.e. memory. In all patients, the projective pathopsychological tests allowed determining subjectively significant disturbances of interpersonal communication that, in combination with selective character of amnesia and intact character of formal intellect, suggested functional mechanisms underlying the analyzing state.

Adolescent↗

[Transient global amnesia following the use of ergots in the treatment of migraine].

INTRODUCTION: Transient global amnesia (TGA) is defined as a selective, or almost selective, deficit of the memory that appears suddenly and lasts less than 24 hours. The aetiopathogenesis of this syndrome remains unknown and different theories have been put forward about its epileptic or ischemic origin, or the relationship that exists with the neuronal depression that is produced in migraine. A number of triggering factors have been described, including the taking of distinct pharmaceutical preparations. CASE REPORT: We report the cases of two patients with a history of migraines who suffered TGA after taking ergotamine and dihydroergotamine, respectively, to treat an attack of migraine. CONCLUSIONS: Given the vasoconstriction effect of these drugs, it was concluded that in both cases the main factor that triggered the TGA was the ingestion of ergots.

Aged↗

Successful thyrotropin-releasing hormone therapy for emotional incontinence and amnesia resulting from mumps encephalitis.

A healthy 7-year-old girl developed emotional incontinence and amnesia associated with mumps encephalitis. Her neurologic findings markedly improved after treatment of daily injection of thyrotropin-releasing hormone tartrate without any adverse effects. Although magnetic resonance imaging revealed no abnormal findings, the findings of Tc-hexamethylpropyleneamine oxime single photon emission computed tomography demonstrated abnormality of left temporooccipital area thought to be responsible for her symptoms.

Affective Symptoms↗

Make love to forget: two cases of transient global amnesia triggered by sexual intercourse.

Transient global amnesia (TGA) is characterized by a sudden onset and by a typical resolution within several hours. Several precipitating events have been proposed: physical exertion, emotional experiences, etc. The aim of this paper was to present two cases of TGA triggered by sexual intercourse and to suggest a possible mechanism for the development of TGA. In both patients, clinical examination revealed elevated blood pressure. Laboratory examinations and brain CTs were normal. EEG demonstrated diffuse dysrhythmia and slow spike-waves, respectively. SPECT revealed hypoperfusion in the left frontal and right medial temporal regions. Various explanations of the mechanism of TGA are discussed. Based on the observed hypoperfusion in the medial temporal regions, a new hypothesis is advanced, suggesting the possibility that TGA occurs due to a pathologically changed or less adaptable anterior chorioid artery, initially constricted by hypotension following a blood shift from the center towards periphery.

Amnesia, Transient Global↗

[Polycythaemia as a ready factor of transitory global amnesia].

Transitory global amnesia (TGA) is an upheaval where the patient has anterograde memory lost of abrupt beginning and an inferior duration to 24 h, that has been related to ischaemic, epileptogenic and migranous ethiology. On the other hand polycythaemia is classified like a prothrombotic disorder that can produce manifold manifestations in the central nervous system, from strokes to psychiatric disturbances of anxious type, and all related to the secondary cerebral hipoperfusión due to hyperviscosity. Two patients, who had a previous diagnostic of polycythaemia suffered an episode of TGA, in addition in one of the two cases a cerebellar hemangioblastoma was found. There are numerous cases reported of brain tumors and other CNS findings diagnosed as a result of an episode of TGA, nevertheless on has not described to the relation between polycythaemia and the TGA. In the TGA a hypoperfusion of the temporal brain hemisphere has been documented and this can be a leading mechanism, so we propose that polycythaemia could ready to suffer a TGA.

Aged↗