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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 26, No 6, November/December 2015
e8
AFRICA
Case Report
A rare case of aortic dissection presenting as pure
transient global amnesia
Hirsh Kaveeshvar, Rabih Kashouty, Vivek Loomba, Noor Yono
Abstract
Transient global amnesia (TGA) is a well-described neuro-
logical phenomenon. Clinically, it manifests with the sudden
onset of a paroxysmal, transient loss of anterograde memory
and disorientation but with intact consciousness. Typically,
symptoms last for only a few hours. We present an unusual
case of aortic dissection presenting with pure TGA in a
patient, who had a positive outcome. This is the second case
report of a patient with aortic dissection presenting with pure
TGA syndrome, but it is the first case in which the patient
survived.
Keywords:
transient global amnesia, aortic dissection, TIA,
emergency, Valsalva
Submitted 28/1/15, accepted 26/7/15
Cardiovasc J Afr
2015;
26
: e8–e9
www.cvja.co.zaDOI: 10.5830/CVJA-2015-061
Transient global amnesia (TGA) is a well-described neurological
phenomenon. Clinically, it manifests with a sudden onset
of a paroxysmal, transient loss of anterograde memory
and disorientation but with intact consciousness.
1
Typically
symptoms last for only a few hours. The aetiology of TGA
remains unclear.
1,2
Few case reports have described a link
between TGA and aortic dissection (AD). We present an unusual
case of AD presenting with pure TGA in a patient who had a
positive outcome.
Case report
A 63-year-old man with a history of hypertension and
hyperlipidaemia suddenly developed anterograde and retrograde
amnesia and was admitted to our hospital. The patient, who
was in the passenger seat of a car, with his colleague driving,
suddenly became pale and dizzy and was not aware of his
surroundings. He repeatedly asked the reason they were in the
car. The patient denied any complaints, including chest pain, but
asked repetitive questions.
On general examination, the patient was afebrile. His blood
pressure was 94/53 mmHg. His neurological examination was
unremarkable, except for anterograde amnesia. Blood tests
revealed mild leukocytosis (15 700 cells/mm
3
). A chest X-ray
showed no abnormalities, a head computed tomography was
unremarkable, and an electroencephalography revealed no
epileptiform discharges.
The anterograde amnesia resolved 10 hours after onset.
However, he remained hypotensive and a mild diastolic murmur
was noted over the aorta. Urgent cardiac echocardiography
revealed Stanford type A AD. The patient was immediately
taken to the operating room and successfully rescued. He was
discharged without any significant neurological symptoms.
Discussion
This case illustrates an example of painless AD presenting with
pure TGA with no focal neurological deficits. The persistence
of hypotension and the presence of an aortic murmur after the
resolution of TGA raised the suspicion of AD.
The aetiology of TGA remains unclear.
1,2
Traditionally, it is
believed to be due to transient cerebral ischaemia, particularly
in the hippocampal formation and mesiotemporal structures;
however, evidence is now accumulating that fails to show
diffusion-weighted imaging hyperintensities within 24 hours of
onset of symptoms.
1,3
AD is a life-threatening emergency and prompt clinical
recognition is essential for treatment.
4
Acute neurological
syndromes in AD are uncommon and typically present with focal
neurological deficits.
5
It can mimic a large group of neurological
symptoms, including TGA, despite the absence of chest pain.
6
In a series of 977 patients, Park
et al
.
7
observed only 63 (6.4%)
patients with painless AD, which may mislead the physician and
delay the treatment. The existence of a pathogenic link between
pure TGA and AD is still unclear.
8
Transient episodes of increased intrathoracic pressure can
potentially precipitate AD.
9
Similarly, transient episodes of
increased intrathoracic pressure due to the Valsalva manoeuvre
Department of Neurology, Henry Ford Hospital, Detroit, USA
Hirsh Kaveeshvar, DO,
hkavees2@hfhs.orgDepartment of Neurology, Icahn School of Medicine, Mount
Sinai Beth Israel, NewYork, USA
Rabih Kashouty, MD
Department of Anaethesiology and Pain Medicine, Henry
Ford Hospital, Detroit, USA
Vivek Loomba, MD
Department of Neurology, North Shore University Hospital,
Hofstra University, NewYork, USA
Noor Yono, MD