Chapter 17

### The bothered and bewildered amnesic patient

Harry, a 62-year-old man with a history of hypertension and anxiety, presented one evening because of the acute onset of an amnesic episode. He had driven to collect his two grandchildren from school that afternoon. The children reported that their grandfather appeared his usual self except that he was unable to find his way home. He drove around the neighbourhood for about three hours before eventually locating his house with the help of the children. Upon returning home his family found him confused and unable to remember the events. I found him perplexed and repeatedly asking where he was and how he came to be there. The children said that his driving seemed normal. Harry could not give an account of the day’s events nor could he remember getting up that morning. He could not recall significant recent events such as an overseas holiday. Physical examination was normal.

I had not encountered this amnesic syndrome before so I phoned a consultant neurologist who informed me that it was probably a classic case of transient global amnesia and that the amnesic state should resolve completely leaving only a memory gap for events that occurred during the episode.

I have subsequently encountered two other episodes over the years including that of a 67-year-old GP friend who found himself all confused at an end-of-line suburban railway station on a line quite remote from his usual route home. The initial experience with Harry was a great help in understanding the disorder and thus helped me to confidently counsel subsequent patients.

DISCUSSION AND LESSON LEARNED

Sometimes we are consulted for a problem that is foreign to our current state of medical knowledge. For me it is often a neurological problem such as transient global amnesia. I find that the best strategy is to contact a helpful consultant or GP colleague (immediately if possible) and talk through the problem.

### All locked in

Many years ago a worried friend contacted me after a flight from London to explain that she had a sudden terrifying experience when she could not speak or use her arms. No one came to her aid because she appeared to be asleep and could not rouse her husband or use the call button. She said that the symptoms gradually abated over the next 15 minutes or so and she felt reasonably normal now. It occurred to me that this was a transient ischaemic attack (TIA) causing the ‘locked in syndrome’ and organised an urgent visit to a neurological unit. Subsequently Bernie has been taking low dose aspirin for 17 years without any further cerebrovascular incidents.

DISCUSSION AND LESSONS LEARNED

• The so called ‘locked in syndrome’ is dramatic and a particular concern because it affects the brain stem. The more dramatic stroke is a catastrophe for the patient and their ...

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