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Concept: Memory disorders

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Dot-like hippocampal hyperintensities (HHs) on diffusion-weighted MRI (DWI) have been reported as an interesting imaging finding of transient global amnesia (TGA) that is characterized by typical anterograde amnesia. However, we found that these dot-like HHs are occasionally seen in some patients without clinical symptoms of TGA.

Concepts: Magnetic resonance imaging, Hippocampus, Anterograde amnesia, Amnesia, Retrograde amnesia, Transient global amnesia, HM, Memory disorders

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The Glasgow Coma Scale (GCS) only assesses orientation after traumatic brain injury (TBI). ‘Post-traumatic amnesia’ (PTA) comprises orientation, anterograde amnesia (AA) and retrograde amnesia (RA). However, RA is often disregarded in formalized PTA assessment. Drugs can potentially confound PTA assessment: e.g. midazolam can cause AA. However, potential drug confounders are also often disregarded in formalized PTA testing. One study of medium-stay elective-surgery orthopaedic patients (without TBI) demonstrated AA in 80% taking opiates after general anesthesia. However, RA was not assessed. Opiates/opioids are frequently administered after TBI. We compared AA and RA in short-stay orthopaedic surgery in-patients (without TBI) taking post-operative opioids after opiate/opioid/benzodiazepine-free spinal anesthesia. In a prospective cohort, the Westmead PTA Scale (WPTAS) was used to assess AA (WPTAS<12), whilst RA was assessed using the Galveston Orientation and Amnesia Test RA item. Results were obtained in n=25 (60±14yrs, M:F 17:8). Surgery was uncomplicated: all were discharged by Day-4. All were taking regular oxycodone as a new post-operative prescription. Only one co-administered non-opioid was potentially confounding (temezepam, n=4). Of 25, 14 (56%) demonstrated AA: five (20%) were simultaneously disorientated. Mean WPTAS was 11.08±1.22. RA occurred in 0%.

Concepts: Traumatic brain injury, Hippocampus, Opioid, Anterograde amnesia, Amnesia, Glasgow Coma Scale, Retrograde amnesia, Memory disorders

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Korsakoff syndrome (KS), most frequently resulting from alcohol dependence (ALC), is characterized by severe anterograde amnesia. It has been suggested that these deficits may extend to other memory components, and notably source memory deficits involved in the disorientation and temporal confusion frequently observed in KS. However, the extent of this source memory impairment in KS and its usefulness for the differential diagnosis between ALC and KS remain unexplored.

Concepts: Alcoholism, Hippocampus, Alcohol abuse, Anterograde amnesia, Amnesia, Differential diagnosis, Confabulation, Memory disorders

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Transient amnestic syndromes are fascinating clinical entities and there are several subtypes. Transient global amnesia (TGA) is characterised by sudden onset of anterograde amnesia with repetitive questioning, lasting less than 24 hours. The pathophysiology of TGA involves the medial temporal lobes and hippocampi. Episodes of TGA are thought to involve venous congestion with Valsalva-like activities, vascular or migrainous mechanisms. In contrast, transient epileptic amnesia manifests as brief and frequent episodes of amnesia due to seizure activity in the temporal lobes. Transient memory disturbances can also be caused by transient ischaemic attack. We describe the first reported case of transient reversible amnesia directly attributable to acute demyelination. This case reminds us that multiple sclerosis relapses may present with acute cognitive impairment rather than the more classical physical symptoms. This is an important learning point in terms of appropriate management and eligibility for disease-modifying drugs.

Concepts: Memory, Temporal lobe, Hippocampus, Temporal lobe epilepsy, Anterograde amnesia, Amnesia, Transient global amnesia, Memory disorders

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Transient global amnesia (TGA) is characterized by sudden loss of memory of recent events, transient inability to retain new information, and retrograde amnesia. We investigated the changes of regional cerebral blood flow in patients with TGA shortly after symptom onset and after recovery using Tc-99m-ethyl cysteinate dimer single-photon emission computed tomography (Tc-99m ECD SPECT) and statistical parametric mapping (SPM) analysis.

Concepts: Medical imaging, Hippocampus, Anterograde amnesia, Amnesia, Single photon emission computed tomography, Retrograde amnesia, Transient global amnesia, Memory disorders

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Emotional material rarely occurs in isolation; rather it is experienced in the spatial and temporal proximity of less emotional items. Some previous researchers have found that emotional stimuli impair memory for surrounding information, whereas others have reported evidence for memory facilitation. Researchers have not determined which types of emotional items or memory tests produce effects that carry over to surrounding items. Six experiments are reported that measured carryover from emotional words varying in arousal to temporally adjacent neutral words. Taboo, non-taboo emotional, and neutral words were compared using different stimulus onset asynchronies (SOAs), recognition and recall tests, and intentional and incidental memory instructions. Strong emotional memory effects were obtained in all six experiments. However, emotional items influenced memory for temporally adjacent words under limited conditions. Words following taboo words were more poorly remembered than words following neutral words when relatively short SOAs were employed. Words preceding taboo words were affected only when recall tests and relatively short retention intervals were used. These results suggest that increased attention to the emotional items sometimes produces emotional carryover effects; however, retrieval processes also contribute to retrograde amnesia and may extend the conditions under which anterograde amnesia is observed.

Concepts: Effect, Memory, Hippocampus, Anterograde amnesia, Amnesia, Emotion and memory, Retrograde amnesia, Memory disorders

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Transient global amnesia (TGA) is a stereotypic condition characterized by anterograde and retrograde amnesia that typically resolves within 24 hours. The pathophysiology of TGA is still unclear. We noted that patients hospitalized with TGA tend to appear in seasonal clusters, and decided to investigate this phenomenon.

Concepts: Hospital, Hippocampus, Season, Anterograde amnesia, Amnesia, Retrograde amnesia, Transient global amnesia, Memory disorders

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Transient global amnesia (TGA) is a transitory, short-lasting neurological disorder characterized by a sudden onset of antero- and retrograde amnesia. Perfusion abnormalities in TGA have been evaluated mainly by use of positron emission tomography (PET) or single-photon emission computed tomography (SPECT). In the present study we explore the value of dynamic susceptibility contrast perfusion-weighted MRI (PWI) in TGA in the acute phase.

Concepts: Medical imaging, Positron emission tomography, Positron, Radiology, Amnesia, Single photon emission computed tomography, Transient global amnesia, Memory disorders

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Transient global amnesia (TGA) is a neurological syndrome that usually occurs in middle-aged or older people. It is characterized by the abrupt onset of profound anterograde amnesia, associated with more variable retrograde amnesia and repetitive questioning. The whole episode lasts no more than 24 h. Almost 60 years after its first descriptions, the etiology of TGA remains unknown. Until now, TGA has been described exclusively as a memory disorder, but there is a growing body of evidence to show that emotional and psychological factors (as anxious and depressive symptoms) are present at different times of TGA. Their role therefore needs to be clarified. First, these factors seem to play a part in triggering TGA, at least for a subgroup of patients, suggesting the existence of an emotional TGA subtype. Second, recent research shows that almost all the TGA patients displayed modifications of their emotional state during the episode, possibly linked to sudden memory loss. The level of depressive and anxious symptoms could even reach a pathological threshold in patients with the so-called “emotional TGA subtype”. Third, the persistence of these depressive and anxious symptoms after the end of the episode could account for lasting memory disorders in some patients. Finally, the analysis of these emotional syndrome and emotional factors and the recent data in neuroimaging could allow us to gain a better understanding of the pathophysiological mechanisms behind TGA. The aim of this review was thus to discuss whether the anxious and depressive symptoms are causative, resultant or coincidental of TGA.

Concepts: Psychology, Memory, Hippocampus, Psychiatry, Anterograde amnesia, Amnesia, Transient global amnesia, Memory disorders

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Transient epileptic amnesia (TEA) is a presumably underdiagnosed syndrome belonging to the group of temporal lobe epilepsies. It can easily be misdiagnosed as transient global amnesia (TGA), transient ischaemic attack, psychogenic amnesia or even dementia. Many patients complain of loss of autobiographical memory and accelerated long-term forgetting. We present a case to emphasize both the importance of diagnosing TEA and the pitfalls between TEA and TGA syndrome.

Concepts: Stroke, Temporal lobe, Hippocampus, Temporal lobe epilepsy, Amnesia, Transient global amnesia, Memory disorders, Transient epileptic amnesia