Case Presentation: A 61-year-old female with past medical history of hypertension and migraine was brought disoriented to the emergency room. According to her husband, patient seemed to be forgetful after sexual intercourse on the same morning. She could not remember her medicines and was asking about their dog who passed away months ago. She denied any headache, weakness or numbness. There was no trauma,recent illnesses or similar episodes in the past. On examination, she was afebrile and hemodynamically stable. A detailed neurological examination was remarkable for recall of 1/3 items after 6 minutes. No other focal neurological deficits were identified.She underwent CT ( computerized tomography ) head and a CT angiogram of head and neck did not show any acute intracranial changes, hemodynamically significant thrombosis or occlusion. MRI Brain was also unremarkable. Lab work including complete blood count , comprehensive metabolic panel , Urinalysis, Vitamin B12 levels ,folate levels and thyroid function test were normal. Urine toxicology screen was negative. Patient remained in observation and within 4 hours, she was back to baseline. She was able to retell the story based on her husband’s recollection of the events. She did not remember statements made during the phase of memory loss. The patient had a complete recovery with no recurrence of symptoms during the 24 hours of observation and was hence discharged.
Discussion: Transient Global Amnesia ( TGA ) is defined as an abrupt episode of impaired memory without clouding of consciousness or focal neurologic signs which must be witnessed by a capable observer, lack epileptic features, and resolve within 24 hours. It is an uncommon disorder with an incidence of less than 10 per 100,000 per year, usually presenting in adults over 50 years old. The etiology of TGA is unclear, but it is known to be associated with triggers. Patients with TGA are more likely to have hypertension, hyperlipidemia, and migraines compared to the overall inpatient population, though this association is controversial. TGA may be associated with ischemia in the mediobasal temporal lobe and hippocampus, which is involved in formation and retrieval of episodic memories. Another possible etiology of TGA is venous congestion, which is supported by the fact that the Valsalva maneuver has been associated with 41% of cases of TGA. Sympathetic activation from emotional events and vigorous activity of the arms have also been associated with TGA. These events can all increase intrathoracic pressure or venous return, which can cause central venous congestion affecting the deep veins draining the thalamus and hippocampus. Incidentally, these activities can also be associated with sexual intercourse, which may explain the association between intercourse and TGA. MRI studies suggest more retrograde venous flow in TGA, especially with an antecedent Valsalva maneuver, compared to controls.
Conclusions: Transient Global Amnesia (TGA) is an uncommon neurological presentation that can be triggered by intense physical or emotional experiences, including sexual intercourse. It is self-resolving and has no long-term outcomes, though it can be severely distressing for patients and their families.