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Concussion Causing Transient Global Amnesia: Further Insights Into Pathophysiology?

OBJECTIVE
To review a rare presentation of Transient Global Amnesia (TGA) in context of concussion with reversible imaging findings.


BACKGROUND
TGA is characterized by sudden temporary loss of anterograde memory accompanied by repetitive questioning without focal neurologic deficits. While risk factors of age above 50 and migraines remain constant, a clear cause is unknown. The association between TGA and concussion is not well defined beyond 2 case reports in the literature. We review the existing literature and examine a case of TGA in temporal relationship to mild traumatic brain injury (mTBI) or concussion.


DESIGN/METHODS
Case Report.


RESULTS
A healthy 38-year-old male with no prior concussions or headaches, sustained a concussion after falling backward on pavement. He presented to the emergency room with retrograde amnesia of events 1 hour prior to his injury with subsequent anterograde amnesia. His exam demonstrated normal language and speech and no other focal neurologic deficits. He was diagnosed with TGA with symptoms lasting for 16 hours before fully resolving. Approximately 24 hours after his injury, he developed a migraine headache and tinnitus that was worse with exertion, lasting for roughly 12 hours. His initial CT head while symptomatic demonstrated an area of hypodensity within the left anterior temporal lobe. 2 days after his presentation, he had an MRI with DWI/SWI as well as an EEG, all of which were completely normal, with complete resolution of the finding on CT. He had no further symptoms after his headache resolved and no recurrence of TGA after 12 months follow-up.


CONCLUSIONS
TGA presenting after a concussion has rarely been reported. We report such a case with imaging findings present during the acute phase that were not present on subsequent MRI suggesting possible reversible vasogenic edema. This may provide insights into the pathophysiology of TGA in this population.