Memory impairments occur in the practice of neurologists no more often than in 3-5% of cases. Usually these are long-term deviations, such as anterograde or retrograde amnesia, which are eliminated after high-quality drug treatment of the root cause. Transient global amnesia is an acute, transient condition accompanied by a total loss of memories of past events with complete preservation of personality and normal orientation in space. The sense of time may be partially lost.
Unlike other forms of amnesia, transient or transient amnesia recedes on its own within a maximum of 24 hours from the beginning of the episode; more often the process lasts 1-2 hours and ends with the complete restoration of the neuropsychic qualities of the individual.
The exact mechanisms of the condition have not been established, therefore there is no need to talk about symptomatic treatment. Urgent identification of the etiology of the process and treatment of the root cause is necessary. This will solve the issue of preventing further relapses. There is no need for inpatient treatment or inpatient diagnostics. The profile specialist is a neurologist.
What is transient global amnesia?
Transient global amnesia (TGA) is a temporary, acute-onset anterograde amnesia that typically occurs in middle-aged and elderly people.
The disorder is often caused by particularly strenuous activities, stressful situations or sexual intercourse, but can also occur with migraines. Studies are inconclusive as to whether there are risk factors for developing TGA, although some suggest an association with pre-existing heart disease, migraine, or a history of hyperlipidemia. Patients often present with repetitive questions and complete anterograde memory loss that resolves within 24 hours. As long as there is disorientation in relation to other people and location, patients do not lose self-awareness. Once resolved, symptoms rarely recur and no other neurological abnormalities are observed with this condition.
Psychogenic amnesia
They do not have an organic basis and arise as a result of the action of protective mechanisms.
- Post-hypnotic amnesia.
- Hysterical amnesia - the development of the concept of hysterical amnesia is associated with the names of Jean-Martin Charcot, Pierre Janet, Joseph Breuer and Sigmund Freud. It is necessary to distinguish between hysteria of traumatic origin (caused by mental trauma or experiences of extreme stress) and hysteria as a transference neurosis associated, according to early psychoanalytic concepts, with internal structural conflict and regression of libido to objects of the oedipal phase of development. Hysterical amnesia of a traumatic nature is caused by the action of the protective mechanism of dissociation. Amnesia in hysterical transference neurosis is caused by the action of repression aimed at representatives and derivatives of the conflict drive.
According to the concept of Charcot and Breuer, when experiencing a traumatic situation, some people experience a so-called hypnoid state - a state of self-hypnosis. In this altered state of consciousness, the encoding of memory elements corresponding to the experience of a given situation occurs. In some cases, these memories, which form an independent structure that does not have associative connections with the rest of the system of autobiographical memories, cannot be reproduced arbitrarily. Access to them is possible only in an altered state of consciousness, which is achieved using hypnotic and trance techniques.
Amnesia caused by the action of repression can be overcome, according to psychoanalytic concepts, through awareness of the repressed material. The latter is achieved through the use of the method of free associations in analytical work.
- Fugue amnesia is amnesia of a dissociative nature. This type of psychogenic amnesia occurs during dissociative fugue - a reaction of flight in a situation of mental trauma or extreme stress. The main feature of a dissociative fugue is sudden, unplanned departure. The dynamics of a dissociative fugue are characterized by passing through the double barrier of amnesia. The first amnestic barrier occurs immediately after the onset of the fugue, with important personal information and memories related to the individual's past life remaining behind the barrier. The first amnestic barrier corresponds to a change in the individual’s personal identity. The second amnestic barrier occurs after the cessation of the fugue state, when memories remaining behind the first amnestic barrier return and memories of events that occurred during the fugue state are dissociated. When passing the second amnestic barrier, the “fugue” personal identity is lost and the individual’s previous identity returns.
- Multiple personality disorder is a dissociative disorder whose main etiological factor is chronic childhood trauma in the context of a relationship with a significant adult (usually parents or surrogates). Multiple personality disorder (or DSM-IV dissociative identity disorder) is sometimes misdiagnosed as schizophrenia
. Multiple personality disorder is characterized by multiple episodes of amnesia both for a number of traumatic situations in childhood and for events that occurred during the so-called switches, that is, when one alter personality ceded control over the individual’s behavior to another alter personality. As with dissociative fugue, amnesia in multiple personality disorder is usually dissociative in nature. Dissociative amnesia in the vast majority of cases (if, for example, they are not accompanied by disturbances in the functioning of the corresponding parts of the brain) is reversible. Recovery of dissociated material is usually complete and occurs either spontaneously or through the use of hypnotic and trance techniques.
Sign and symptoms
A person with an attack of TGA is almost incapable of creating new memories, but usually appears otherwise mentally alert and clear, having full knowledge of self-identity and the identity of close relatives, and retaining intact perceptual skills and a wide repertoire of complex learned behaviors. The person simply cannot remember anything that happened beyond the last few minutes, while memory of events more distant in time may or may not be largely intact. The degree of amnesia is great, and the period during which the person is aware of his condition is often accompanied by anxiety.
Agatha Christie's True Detective
On the evening of December 3, 1926, the author of popular detective novels, Agatha Christie, mysteriously disappeared from her home in Sunningdale. The next morning, her empty car was found in Newlands Corner, an hour's drive from where she disappeared. Initially, the writer's husband, who was said to want to divorce her, was accused of kidnapping Christie. Many thought that he simply killed her.
Agatha Christie. Photo: www.globallookpress.com
However, Agatha was found alive and unharmed on 14 December at the Swan Hydropathic Hotel in Harrogate, where she had been staying under the name of her husband's mistress, Teresa Neil . The writer claimed that she had no idea how she ended up in this place.
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It is still not known for certain what happened to Christie during those 11 days: whether it was an attempt to frame her husband, or whether the author of popular detective stories actually forgot for a while who she was. The latter version is supported by eyewitness accounts: for example, one of them saw how, on the day of Madame Christie’s disappearance, she walked confusedly down the road in a thin dress, despite the fact that it was winter.
Shortly before the mysterious disappearance and news of the divorce, the writer lost her mother. The woman took her death very hard. The abandoned car indicates that Christie was in an accident. And due to the fact that she had to endure so many sad events in a short period of time, it is not surprising that the injury could lead to short-term memory loss.
Causes
There are many theories regarding the true etiology of TGA, but none have been proven. These theories included vascular phenomena, depression, migraine, epilepsy, or psychogenic origin. Studies have confirmed and refuted arterial ischemia as the source. Vascular congestion has been considered and remains one of the leading hypotheses, although issues associated with certain age groups and the fact that it is not observed in venous thrombosis have yet to be explained. Moreover, the disorder rarely occurs more than a couple of times in a patient's life. As such, theories generated regarding the etiology of transient global amnesia do not explain all clinical aspects of the disorder to date.
An hour and a half for an unknown Briton
In March 2005, one of the UK residents came to the dentist. The patient's name is still kept secret, only that he is a Gulf War veteran. The specialist gave the patient anesthesia and removed the nerve in the tooth. After the routine procedure, the man became ill: he turned pale and began to speak unnaturally slowly. The veteran spent the next three days in the hospital, where he was diagnosed with amnesia. Since then, every morning the Briton wakes up with the thought that he needs to go to the dentist, and can remember new information for no longer than 90 minutes.
Leicester University professor Gerald Burgess said it was unprofessional to blame the dentist for the man's illness, as scientists did not find any damage in the patient's brain region, which is responsible for memory. Experts still don't understand what triggered the memory loss.
Amnesia did not affect any other features of the British psyche. He lives an ordinary life, remaining a sociable person. The only thing that distinguishes him from those around him is the need to write down everything that happens to him in an electronic organizer.
Epidemiology
The incidence of TGA is approximately 5.2-10/100,000 per year in the general population. In persons aged 50 years and older, the incidence increases to 23.5–32 per 100,000 per year. Most reported cases have been in patients aged 50 to 80 years. There is no gender difference. Although no clear risk factors were identified, the disease was more common in patients with a history of coronary artery disease and hyperlipidemia. There was no history of ischemic stroke, diabetes, or hypertension. Many studies have demonstrated concomitant migraine in patients, but not in all cases.
Pathophysiology
The origin of transient global amnesia is thought to be in the hippocampus, particularly CA-1 and Sommer's sector, as well as the mediobasal temporal lobe. The noted region of the hippocampus is a watershed of the brain that is particularly susceptible to various metabolic stresses, possibly due to sensitivity to cytotoxic uptake or release of glutaminergic substances. These areas can be affected bilaterally or unilaterally, but most often occur on the left side. However, with functional imaging such as functional MRI, reversible defects have been observed on both sides. The patient temporarily has difficulty forming as well as retrieving new memories.
The pattern observed with TGA correlates with the affected side of the brain. In bilateral cases, the patient will have impairments in both visuospatial and verbal memory. Predominant brain lesions demonstrate associated language deficits.
Clive Wareing, caught between past and future
On March 27, 1985, a 46-year-old British musicologist named Clive Wareing became ill with herpetic encephalitis (a very rare form of the herpes simplex virus), which affected the central nervous system. As a result, Wareing suffers from both anterograde and retrograde amnesia, meaning he does not remember events from his past and cannot remember new information.
The British remember new information only for 7-30 seconds. And from his life before 1985 - only that he had children from a previous marriage, whose names, however, he also forgot.
In this case, Wareing's procedural memory functions normally. If you show him the same film for several days in a row, he will forget that he has already watched it, but the next time he watches it he will be able to predict the development of events, without understanding how he knew about it.
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The unusual patient’s wife, Deborah , whom the Briton married just a year before his illness, wrote a book about him, “Always Today.”
Diagnostics
— History and physics.
Typically, patients experience acute memory loss lasting several hours. Sufferers will exhibit repetitive questions and will not remember how they got to where they are or what they were doing at the time immediately preceding the onset. Often, caregivers will report recent activities such as vigorous exercise, sexual intercourse, or extreme stress. Patients do not report loss of consciousness or lose the ability to self-identify. There are no associated neurological or other cognitive impairments. There will be no history of trauma and symptoms will resolve within 24 hours of onset. The presence of active seizures excludes TGA, whether new or chronic. Symptoms are absent when the patient wakes up in the morning, but occur later in the day.
Forgotten Love Krickit Carpenter
In September 1993, 10 weeks after their wedding, spouses Kim and Krickit Carpenter were involved in a car accident. After a medical examination, it turned out that she did not remember the last year and a half of her life. Including Kim, whom I met during this period. Seeing him as a stranger, Krikit refused to communicate with her husband. Instead, she increasingly remembered her ex-boyfriend Todd . However, Kim did not give up and managed to make his wife fall in love with him again. As a result, the couple remarried, Krickit gave birth to two children. Despite the efforts of doctors, the woman never regained her memory of those 18 months.
Kim wrote a book, The Oath, based on events in his life. In 2012, this story was filmed.
Treatment
Treatment of transient global amnesia is mainly supportive. There is no specific therapy for the condition and it is not necessary. The patient should be carefully assessed for any associated neurological deficits or signs of head injury that would exclude TGA as a diagnosis. The patient should be observed in the hospital until the memory deficit resolves. Intravenous thiamine should be considered. Relapses, although they do occur, are rare. Once the memory deficit is corrected, the patient does not require any restrictions on driving or other activities.
Treatment and rehabilitation for amnesia (amnestic syndrome)
The effectiveness of treatment depends on the speed and correctness of identifying the cause that caused amnesia and, if possible, eliminating it.
Drug therapy is carried out by a doctor of appropriate qualifications: a neurologist, a therapist, an infectious disease specialist, a psychiatrist.
In the case of persistent, progressive amnesia, in addition to drug therapy, the patient needs psychological support and rehabilitation, that is, restoration of functions lost due to the disease. A neuropsychologist or a specially trained psychotherapist or clinical psychologist can help him with this.
Specific methods of psychological assistance used to treat memory disorders resulting from brain damage can be classified as follows:
- methods to reduce memory requirements;
- methods aimed at improving memory components;
- methods used to teach the patient not only to recognize the "critical" demands of daily life, but also his individual capabilities to overcome them.
Forecast
The prognosis for “pure” TGA is very good. It does not affect mortality or morbidity and, contrary to earlier understanding of the condition, TGA is not a risk factor for stroke or coronary artery disease. Recurrence rates have been reported differently, with one systematic estimate suggesting the relapse rate to be less than 6% per year. Transient global amnesia "is widely considered a benign condition that requires no further treatment other than to reassure the patient and family." The most important part of treatment after diagnosis is taking care of the psychological needs of the patient and his family. Seeing a once competent and healthy partner, sibling or parent lose the ability to remember what was said just moments ago is very upsetting, and it is often the family that needs reassurance.
The Curious Case of Benjamin Kyle
Benjamin Kyle.
Photo: Commons.wikimedia.org/ Adam Harbottle In the summer of 2004, on the steps of a fast food store in Georgia, there was a man who clearly needed help, but could not tell anything about himself. He did not remember his name, did not have any documents or personal belongings with him, and did not know how he ended up in that place. The unknown man was immediately sent to the city hospital because his skin was swollen and cracked from sunburn, and his eyes were practically blind from cataracts. Based on the results of the examination, the man was diagnosed with amnesia and dissociative identity disorder. The patient was given a temporary name - Benjamin Kyle , and in order to establish his real name and origin, he was put on the federal wanted list. He remains the only American listed as missing, even though authorities know his whereabouts. Despite numerous attempts to establish Kyle's real identity, this was never done.
This case is still unique in US legal and civil practice. Throughout this time, Kyle remains in a kind of legal vacuum, unable to get a new Social Security card, open a bank account or line of credit. Since the man’s real identity is unknown, he cannot restore the unique number in the social security register. On social networks several times they organized a collection of signatures with a request to issue the American a new number. However, each time the initiative failed, not finding sufficient support in society
