Transient global amnesia or embolic limbic stroke

Case contributed by Dr Charlie Chia-Tsong Hsu

Presentation

62 year old male presented with acute confusion. Initial CT head is normal. Patient was admitted under the geriatric physician and MRI study was performed 24 hours after admission. "Rule out organic cause"

Patient Data

Age: 60 years
Gender: Male

Diffusion weighted imaging (DWI) sequence shows a hyperintense focus in the lateral hippocampal body. The lesion abuts the temporal horn. The focus is hypointense on the corresponding ADC map, showing true restricted diffusion. The remaining MRI sequences are unremarkable (not shown). 

Dilemma (personal opinion only)
1) Is this an artefact?  
2) Does the patient has trasient global amnesia (TGA)?
Transient global amnesia (TGA) is not a terminology that rolls off the tongue and the clinical diagnostic criteria is rather cumbersome. The admitting ED physician described the patient as "confused and disorientated" but by academic standard this is not sufficient. 

3) Is this a case of "embolic limbic stroke"?
Possibly. If we remove the over sensationalized definition of TGA, this entity may simply represent embolic stroke of the hippocampus. 

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Case Information

rID: 19072
Case created: 4th Aug 2012
Last edited: 30th Jan 2016
Inclusion in quiz mode: Excluded

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