"Forgettable" Sex: A Case of Transient Global Amnesia Presenting to the Emergency Department

Kevin Maloy, MD; Jonathan E. Davis, MD

Disclosures

J Emerg Med. 2011;41(3):257-260. 

In This Article

Case Report

A 54-year-old post-menopausal woman presented to the ED complaining of "memory loss" after sexual intercourse. The patient was in her usual state of health until approximately 1 h before ED arrival, when she experienced the acute onset of short-term memory loss coinciding with sexual climax. Both the patient and her husband stated that after climax she was unable to recall events of the preceding 24 h. In addition, she had difficulty incorporating new memories (forgetfulness). Her husband stated that she remained cognizant of herself and was able to recognize him throughout the episode. Profound amnestic symptoms lasted approximately 20 min, with a gradual resolution over the following 40 min. At the time of ED presentation, her symptoms were near-totally resolved. There was no alteration in level of consciousness reported at any time during the episode. There was no suggestion of other loss of specific neurologic function. She denied headache. She denied any form of recent head trauma. The past medical history was unremarkable, including past history of transient ischemic attack (TIA), migraine headache, other neurologic conditions, psychiatric conditions, or known seizure disorder (personal or family history). Importantly, she denied prior episodes of similar symptoms. The patient admitted to occasional alcohol use, but denied ingestion on the day of presentation. She also denied over-the-counter, prescription, or illicit drug use (including sedative use).

The patient was alert, oriented, and conversant, with vital signs as follows: blood pressure 132/76 mm Hg, pulse rate 67 beats/min, respirations 20 breaths/min, and temperature 37°C. The oxygen saturation was 100% on room air. Initial serum glucose was 107 mg/dL. Comprehensive physical and neurologic examinations were entirely normal, including mental status, cranial nerve, motor, sensory, and cerebellar testing. She did not exhibit deficits in long-term memory, judgment, attention, language, or emotional lability.

Initial laboratory testing was normal (complete blood count, serum chemistry panel, coagulation profile). An electrocardiogram was normal. A non-contrast head computed tomography (CT) scan was normal.

The patient's symptoms resolved completely shortly after ED arrival. Emergent Neurology consultation was requested for evaluation of possible TIA. After a comprehensive evaluation, a presumptive diagnosis of transient global amnesia (TGA) was suggested by the Neurology service. The Neurology service made arrangements for outpatient magnetic resonance imaging (MRI), including MR angiography, and recommended empiric treatment with aspirin (81 mg daily) pending imaging results. The patient was discharged home from the ED with her husband after consultation. A follow-up MRI study of the head obtained as an outpatient was normal.

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