Recurrent orthostatic global amnesia in a patient with postoperative hyperfibrinogenemia.
Transient global amnesia (TGA) is characterized by sudden, temporary dysfunction of antegrade and recent retrograde memory without other neurologic deficits. Although there is sometimes a precipitating event, the origin of TGA remains controversial. We encountered a patient who developed recurrent TGA when upright, in whom the symptom promptly and regularly resolved when supine. Symptoms began about a week after cardiac surgery concurrent with marked hyperfibrinogenemia and acceleration of the erythrocyte sedimentation rate, and abated without recurrence when these laboratory abnormalities were ameliorated by anticoagulant and corticosteroid therapy. Diagnostic studies, including temporal artery biopsy and cerebral angiography, disclosed no anatomic vascular pathology. This is the first report of TGA associated with postoperative inflammation in which amnesia was provoked by orthostatic positioning. In conclusion, these observations implicate ischemia caused by hemodynamic vascular insufficiency as a possible cause of TGA.
Sealove
Brett A
BA
Mount Sinai School of Medicine, New York, New York 10029, USA.
Aledort
Louis M
LM
Stacy
Charles B
CB
Halperin
Jonathan L
JL
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D020236:Amnesia, Transient Global / Q000097:blood / Q000188:drug therapy / Q000209:etiology*; D000925:Anticoagulants / Q000627:therapeutic use; D001024:Aortic Valve Stenosis / Q000150:complications / Q000601:surgery; D001705:Bioprosthesis; D001799:Blood Sedimentation; D001026:Coronary Artery Bypass; D004244:Dizziness; D005340:Fibrinogen / Q000032:analysis*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000601:surgery; D018917:Optic Neuropathy, Ischemic / Q000150:complications; D011183:Postoperative Complications / Q000097:blood / Q000188:drug therapy / Q000209:etiology*; D012008:Recurrence; D016683:Supine Position; D013617:Tachycardia, Supraventricular / Q000150:complications; D019851:Thrombophilia / Q000097:blood / Q000150:complications*
D000305:Adrenal Cortex Hormones; D000925:Anticoagulants; D005340:Fibrinogen