Initial electroencephalography after spontaneous resolution of symptoms showed intermittent right frontotemporal spikes followed by slow waves. Routine blood tests and computed tomography of the head were unremarkable. Montreal Cognitive Assessment (MoCA) revealed a persistent anterograde amnesia with no further cognitive impairments (score 26/30). On examination, he was fully oriented without focal neurological deficits. Past medical history included hypertension paroxysmal atrial fibrillation for which he took apixaban 2 × 5 mg daily mitral valve insufficiency and a recent urinary tract infection treated with ciprofloxacin. A similar episode had occurred the previous day. We report the first case of a patient fulfilling the clinical criteria for TEA in the presence of a focal hippocampal lesion on diffusion imaging, and argue that, in this constellation, early post-stroke seizures are the most likely diagnosis.Ī 70-year-old man presented to the emergency department after a 30-min episode of anterograde amnesia and disorientation. ![]() In TGA, punctate hippocampal foci of restricted diffusion develop in up to over 80% of patients. ![]() Diffusion abnormalities on magnetic resonance imaging (MRI) are rarely observed in TEA, tend to be diffuse, and likely represent a postictal phenomenon. Memory impairment in TGA, in contrast, lasts longer, rarely recurs, and is not believed to be of epileptic origin. Diagnostic criteria for TEA are recurrent short episodes of disturbed memory sparing of other cognitive domains and clinical or electroencephalographic (EEG) evidence of seizure activity or response to anticonvulsant medication. It suggests that focal diffusion-restricted hippocampal lesions, as seen in TGA, might be ischemic and thus highlights the importance of considering post-stroke seizures as a possible cause of transient memory disturbance.ĭifferential diagnoses for atraumatic temporary memory loss include cerebral ischemia, transient epileptic amnesia (TEA), and transient global amnesia (TGA). Our report contributes to the current discussion of clinical challenges in the differential diagnosis of transient memory disturbance. Both symptoms and EEG changes subsided under anticonvulsant treatment with levetiracetam. EEG and MRI revealed predominantly right frontotemporal spikes and a punctate diffusion-restricted lesion in the left hippocampus, respectively. ![]() The presenting complaint were recurrent episodes of short-term memory disturbance which manifested as isolated anterograde amnesia on neurocognitive evaluation. Case presentationĪ 70-year-old patient was identified in clinical practice in our tertiary care centre and was evaluated clinically as well as by repeated electroencephalography and magnetic resonance imaging. We argue how careful consideration of clinical, electrophysiological and imaging findings can resolve this apparent contradiction and lead to a diagnosis of early symptomatic post-stroke seizures that links brain structure to function in a new, clinically relevant way. ![]() We report the case of a patient with recurrent episodes of disturbed memory suggestive of transient epileptic amnesia, and a focal hippocampal lesion typically associated with transient global amnesia.
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