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Transient global amnesia (TGA) is a typical clinical syndrome characterized by acute, predominantly anterograde amnesia. New epidemiological data assume a significantly higher annual incidence than previously assumed, namely around 15 cases per 100,000 people. Those affected, usually over the age of 50, cannot remember new memory content for longer than 30-180 seconds and therefore ask repetitive questions about current events. All other cognitive functions are unimpaired, and everything previously learnt, e.g. driving or cooking, can be carried out. The episodes are self-limiting and by definition subside within 24 hours. At least 10% of those affected will experience 1-5 recurrences in the future. The punctate lesions in the hippocampus, which are found on MRI in at least 50% of patients after 24-72 hours, are distributed 2/3 unilaterally and 1/3 bilaterally. Using 7 Tesla MRI the frequency of detected lesions increases to 90% compared to 50% with 1.5 or 3 Tesla. Beyond the punctiform hippocampal lesions, other memory-related network disorders, including the default network, are also suggested to be involved in the pathomechanism of TGA. TGA etiology and pathophysiology are not known in detail. Vascular, migraine-like, epilepsy-like, and psychogenic mechanisms are discussed. Triggers of the episodes are often physical exertion with a Valsalva character. Management is aimed at identifying the syndrome based on the typical clinical presentation and ruling out possible differential diagnoses with similar symptoms. During the TGA, the usually anxious relatives should be reassured of the benign and inconsequential nature of the episode., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Objective . To determine if there is any correlation between the electroencephalographic and neuroimaging findings in patients with Transient Global Amnesia (TGA). Methods: We retrospectively reviewed files of the First Department of Neurology of AHEPA University Hospital, including patients with a clinical diagnosis of TGA. Only patients who had the characteristic high signal in the temporal lobes in the DWI MRI and those who underwent electroencephalographic recording (EEG) were selected. Results: Out of 28 patients, 8 were selected. We found that 6 out of 8 patients (75%) who had imaging findings in DWI, in at least one medial temporal lobe, also had had intermittent slow theta waves on the electroencephalographic recording. Of these 6 patients, 3 (50%) had bilateral EEG findings, 2 patients (33,3%) only had findings on the left hemisphere and 1 (17%) had on the right hemisphere. 3 out of 6 patients (50%) had electroencephalographic dominance on the left, while 2 out of the 6 (33%) had on the right. In 2 patients with imaging findings in DWI no anomalies were demonstrated on EEG. In 3 out of 8 patients, both MRI and EEG findings correlated on the same side, while 1 patient had opposite findings, depending on which hemisphere the EEG anomalies dominated. Conclusions: There is no absolute matching between the DWI MRI and EEG findings in patients with the clinical diagnosis of TGA. However, there is some degree of correlation, when we focus on the focal dominance of the EEG anomalies, although not statistically significant.

Background: Transient epileptic amnesia (TEA) is a rare phenomenon in temporal lobe epilepsy that is often unrecognized or misdiagnosed as transient global amnesia (TGA). It is postulated that TEA is due to both ictal and postictal disturbances. Response to antiseizure medication underlines its epileptic nature. In view of the increasing incidence of new-onset epilepsies in old age, an increase in TEA can be expected in the future., Objective: Analysis of TEA features in a monocentric case series., Material and Methods: A search in our electronic patient data base yielded 10 patients with TEA out of 7899 patients over a period of 8 years. Clinical and paraclinical features as well as findings of additional examinations were retrospectively collected. Data are given as mean ± SD., Results: All 10 patients were diagnosed with temporal lobe epilepsy. The mean age at manifestation of TEA was 59.1 ± 6.7 years, the diagnosis was made with a delay of 21.9 ± 26.3 months. The TEA lasted on average 56 ± 37 min, and 16 ± 9.9 TEA episodes per year were reported by the patients; out of the 10 patients 6 reported that TEA usually occurred upon awakening. In 9 of 10 patients, there was evidence of typical seizure symptoms or other semiological elements during TEA. Interictal neuropsychological disturbances of temporal functions were seen in 8 of 10 patients and evidence of depressive disorder in 6 of 10 patients. Video EEG recordings revealed epileptiform activity during sleep in 4 patients over the left and in 2 patients over both temporal regions. In 3 patients, magnetic resonance imaging displayed typical alterations of the temporomesial structures (in 2 patients on the left and in 1 the right side). Antiseizure medication improved seizure control in 7 of 10 patients (seizure freedom in 6 patients), 3 patients were lost to follow-up., Discussion: TEA is rare, occurs in older adults and is correctly diagnosed after about 2 years. Thorough assessment of additional symptoms and circumstances, the recurrent occurrence as well as typical EEG and imaging findings of temporal lobe epilepsy enables the distinction between TEA and TGA., (© 2022. The Author(s).)

Memory Loss - a Case of Sudden Amnesia Abstract. Transient global amnesia (TGA) is a clinical diagnosis with typical signs of an anterograde and retrograde amnesia. The underlying mechanisms are yet unknown, different hypotheses are being discussed. Ultimately there is a temporary dysfunction of the hippocampi. Consistent with this, transient uni- or bilateral punctiform hyperintense lesions may be found on DWI-MRI sequences, usually without correlation on FLAIR-weighthed MR-images. Symptoms usually resolve within twenty-four hours. There is no need for a specific therapy. A prophylactic therapy, such as antithrombotic treatment, is not indicated. The prognosis is usually good, the risk of a recurrence is about 18%.

Transient global amnesia (TGA) is a clinical syndrome characterized by anterograde amnesia, mild retrograde amnesia, and confusion up to 24 hours. Most commonly seen in patients older than 50 years, TGA results from the temporary impairment of short-term memory formation. Clinically, patients have time disorientation and often ask repeated questions regarding the day's events. Vomiting, headache, blurry vision, dizziness, and nausea may be present. A physically or psychologically stressful precipitating event, such as emotional stress, significant physical exertion, exposure to extreme temperatures, high-altitude conditions, Valsalva maneuver, acute illness, or sexual intercourse, is often the cause. The pathophysiology of TGA is not well understood but may be related to impaired venous drainage of the hippocampus. The diagnosis is primarily clinical, but recent studies suggest that magnetic resonance imaging may be helpful. TGA is self-limited and resolves within 24 hours. There is no established treatment for episodes. The lifetime recurrence rate is 2.9% to 23.8%. Recent evidence suggests an association between TGA and migraine headaches as well as takotsubo cardiomyopathy. No apparent increased risk of cerebrovascular events occurs in patients who have had an episode of TGA. There is conflicting evidence as to whether an episode of TGA predisposes to future seizures or dementia.

Background: Transient global amnesia (TGA) is a clinical syndrome characterized by a temporary short-term memory loss with inability to retain new memories, usually lasting 2 to 8 h. TGA may be related to several medical procedures, including angiography, general anesthesia, gastroscopy., Case Presentation: We report a 58-year-old woman who experiencing TGA one hour after the execution of her first-time nasopharyngeal swab for COVID-19. Brain MRI showed a typical punctate Diffusion Weight Image (DWI) hippocampal lesion., Conclusions: This is the first report of TGA after the execution of nasopharyngeal swab for COVID-19. This association lengthen the list of medical procedures associated with TGA, and we discuss the possible plausible mechanisms by which a nasopharyngeal swab could trigger TGA.

Transient Global Amnesia (TGA) constitutes an enigmatic amnestic condition. In view of the admittedly limited knowledge regarding the nature of TGA, we decided to systematically review existing evidence for the generally regarded benign course of the disease. MEDLINE, EMBASE, CENTRAL and PsycINFO were searched for relevant articles. Observational (case-control, cross-sectional and cohort) controlled studies were retrieved. TGA diagnosis was made according to the diagnostic criteria of Caplan, validated by Hodges and Warlow. The TGA group was compared with either healthy controls (HC) or/and individuals with transient ischaemic attacks (TIA). The long-term risks of dementia, epilepsy, psychological-emotional disturbances, as well as long-term vascular and (vascular or nonvascular) mortality risks, were evaluated. Quality assessment was based on the Newcastle-Ottawa Scale. Literature search provided 12 eligible articles. Retrospective, prospective or mixed cohort designs were implemented in every study. Five articles registered a high quality, five registered a moderate quality, while two articles were assessed as part of the grey literature (conference abstract, abstract in English-article in Spanish). Overall, retrieved evidence was suggestive of similar vascular and mortality risks in TGA patients and HC, while TIA individuals exhibited elevated risks. Moreover, psychological disturbances were comparable between TGA and healthy individuals. On the other hand, studies for dementia and epilepsy obtained contradictory results, indicating both a similar and an increased risk in the TGA group compared to the HC group. Therefore, additional high-quality studies are warranted for the acquisition of more determining conclusions regarding the long-term risk of dementia and epilepsy in TGA., (© 2021 Walter de Gruyter GmbH, Berlin/Boston.)

This case was a 50-year-old healthy woman. After repeated transient amnesia, she developed tonic-clonic seizures and was admitted to our hospital. The brain MRI showed FLAIR hyperintensities in the left temporal lobe and EEG showed an epileptic discharge starting from the left temporal region. Based on these findings, we diagnosed temporal lobe epilepsy associated with acute limbic encephalitis. While she experienced recurrent transient amnesia, her cognitive functions were preserved except for her memory. These symptoms and EEG findings were consistent with transient epileptic amnesia (TEA). Acute limbic encephalitis that occurred in a healthy middle-aged woman may be antibody-mediated encephalitis, requiring immediate immunotherapies. In this case, GABA B receptor antibodies in cerebrospinal fluid were found positive. This is the first report showing that TEA was caused by GABA B receptor autoimmune encephalitis.

Background: Transient global amnesia (TGA) is a syndrome featuring acute anterograde amnesia as the most striking clinical symptom. Its etiology is still a matter of debate. Most neurological guidelines allow the diagnosis on the basis of clinical criteria only; a more extensive evaluation is recommended only for patients with "red flags" like severe headache, nausea or vomiting, or metabolic abnormalities. The aim of our study was to assess the frequency of a severe underlying disease or alternative diagnoses (mimics) in patients fulfilling the clinical criteria., Methods: We evaluated the medical records and the imaging data of an unselected consecutive cohort of patients with suspected TGA over a 7-year period. All patients were hospitalized and received a neurological workup including brain imaging, color-coded duplex sonography of the brain supplying arteries, electroencephalography, and laboratory studies of blood and (in selected cases) cerebrospinal fluid., Results: 163 patients with 166 episodes of suspected TGA were hospitalized (3 patients twice). After the workup, the diagnosis of TGA was confirmed in 148/166 (89.2%) episodes ("simple TGA"). Eighteen patients (10.8%) either had an alternative diagnosis or a severe comorbidity that was assumed to have had an impact on the occurrence of the amnestic episode ("complicated TGA/mimic"). The most important differential diagnosis was stroke (11 patients, 6.6% of all TGA suspects and 61.1% of the complicated TGA/mimic group). Other mimics were transient epileptic amnesia (2 patients) and steroid-induced delirium (1 patient). Important comorbidities that had not been obvious at the time of presentation were severe sleep apnea (2 patients), triptan overuse (1 patient), and an involuntary amlodipine intoxication during TGA., Conclusion: As approximately every tenth patient with suspected TGA either had an alternative diagnosis or a severe comorbidity, which had not been obvious at the time of admission, we consider in-patient treatment of all suspected TGA cases as appropriate, preferably in the setting of a stroke unit, as ischemic stroke was the by far most important diagnosis mimicking TGA., (© 2021 S. Karger AG, Basel.)

Background and Purpose: Diagnostic uncertainty is common in the emergency evaluation of neurological conditions such as acute confusional states, particularly for non-neurologists. We aimed to investigate the clinical recognition process of transient global amnesia (TGA) before arrival at the hospital and in the emergency department (ED)., Methods: In this retrospective observational study, medical records of 365 patients with TGA were analysed concerning mode of arrival, symptoms and suspected diagnosis made by pre-hospital medical care providers and the ED neurologist., Results: More than half of the 248 patients who were evaluated before arrival at the hospital (N = 157, 63.3%) received a diagnosis of suspected stroke, whereas TGA was considered in only 16 patients (6.5%), with recognition of acute amnesia in 150 patients (60.5%) and disturbed orientation in 86 patients (34.7%). Repetitive questions by the patient were noted in 28 patients (11.3%). In contrast, in 355 patients (97.3%), TGA was considered the primary diagnosis by the ED neurologist. Diagnosis in the ED was achieved by documenting ongoing impairment of episodic verbal memory (100.0%), repetitive questions as a prominent ancillary finding (95.5%) and the lack of focal neurological symptoms (100.0%) or by carefully obtaining collateral history suggestive of anterograde memory disturbance (89.9%) and/or repetitive questions (85.7%)., Conclusion: Recognizing TGA crucially depends on identifying isolated anterograde episodic long-term memory disturbance or its observable effects such as repetitive questions and actions., (© 2020 European Academy of Neurology.)

Objective: To analyze how the evidence of hippocampal diffusion-weighted imaging (DWI) lesions may support the clinical diagnosis of transient global amnesia (TGA)., Methods: In this retrospective observational study, 390 consecutive patients with isolated TGA were analyzed, who were evaluated at our institution between July 1999 and August 2018. The size, location, and number of lesions and time-dependent lesion detectability were examined. The incidence of DWI lesions was reviewed with regard to different levels of clinical diagnostic certainty upon presentation to the emergency department., Results: Hippocampal DWI lesions were detected in 272 (70.6%) patients with TGA, with a mean of 1.05 ± 0.98 (range 0-6) and a mean lesion size of 4.01 ± 1.22 mm (range 1.7-8.6 mm). In the subgroups of lower diagnostic certainty (amnesia witnessed by layperson or self-reported amnestic gap), DWI was helpful in supporting the diagnosis of TGA in 76 (69.1%) patients. In 187 patients with information about the exact onset, DWI lesions were analyzed in relation to latency between onset and MRI. Lesions could be detected at all time points and up to 6 days after symptom onset in individual patients; the highest rate of DWI-positive MRI (93%) was in the 12-24 hours time window., Conclusion: MRI findings can support the diagnosis of TGA and may be particularly valuable in situations of low clinical certainty. DWI-ideally performed with a minimum delay of 20 hours after onset-should therefore be considered a useful adjunct to the diagnosis of TGA., (© 2020 American Academy of Neurology.)

Acute amnestic syndromes are usually rare clinical events occurring in emergency situations. Etiological diagnosis can be challenging and underlying causes diverse. They can be transient and totally reversible, or accompanied by other neurological symptoms resulting in serious and irreversible brain damage. Pathophysiology of these syndromes mainly corresponds to structural or functional alteration of memory circuits, including those in the hippocampus. One of the most frequent forms is transient global amnesia (TGA), characterized by sudden onset of anterograde amnesia lasting less than 24  hours, in the absence of other neurological signs or symptoms. Another acute and transient memory disorder is transient epileptic amnesia (TEA), due to focal crisis activity. Stroke injuries occurring at strategic memory-related sites can also present as sudden episodes of amnesia. In addition to neurological etiologies, amnesia may be a symptom of a psychiatric disorder (dissociative amnesia). Traumatic brain injuries, autoimmune encephalitis and acute toxic metabolic disorders can also cause amnesia and should be included among the differential diagnoses. In this review, we summarize the most relevant clinical findings in acute amnestic syndromes, and discuss the different ancillary tests needed to establish a correct diagnosis and management as well the best treatment options. Relevant anatomical and pathophysiological aspects underlying these conditions will be also be presented., (Copyright © 2020 Elsevier B.V. All rights reserved.)

A 60-year-old, right-handed woman was admitted to our hospital for amnesia as the only neurological abnormal findings following the autonomic symptoms and transient episodes of loss of awareness. EEG during the amnesia showed rhythmic alpha activity arising from the left mid-temporal region. Although this ictal activity showed evolution in the frequency and amplitude, the location was limited in the bilateral temporal areas. After the EEG evaluation, her amnesia was resolved immediately, suggesting that her presentation was transient epileptic amnesia (TEA). Meanwhile, given the clinical course and MRI findings (high intensity in the bilateral mesial temporal areas, more on the left), she was diagnosed with non-herpetic limbic encephalitis and treated with steroid and anti-epileptic drugs, leading to the positive outcome. The ictal EEG findings during TEA as the one of the presentation in acute phase of non-herpetic limbic encephalitis may contribute to further investigation of underlying mechanism of TEA.

Background and Purpose: Transient global amnesia (TGA) is characterized by a sudden onset of anterograde amnesia lasting up to 24 h. One major differential for TGA is transient epileptic amnesia, which typically lasts < 1 h. However, TGA can also be short in duration and little is known about the time trends, characteristics and prognosis of TGA cases lasting < 1 h., Methods: We compared the clinical features of TGA ascertained in two independent cohort studies in Oxfordshire, UK [Oxford cohort 1977-1987 versus Oxford Vascular Study (OXVASC) 2002-2018] to determine the time trends of clinical features of TGA. Results were validated in another independent contemporary TGA cohort in Italy [Northern Umbria TGA registry (NU) 2002-2018]. We compared the risk factors, clinical features and long-term prognosis (major cardiovascular events, recurrent TGA and seizure/epilepsy) of patients presenting with episodes lasting < 1 h versus those lasting ≥ 1 h., Results: Overall, 639 patients with TGA were included (114 Oxford cohort, 100 OXVASC, 425 NU). Compared with the original Oxford cohort, there were more cases with TGA lasting < 1 h in OXVASC [32 (32.0%) vs. 9 (8.8%)] and NU (11.8% vs. 8.8% in Oxford cohort). In both OXVASC and NU, patient age, vascular risk factors and clinical features were largely similar between those with TGA lasting < 1 h versus those lasting ≥ 1 h. Moreover, there was no difference in the long-term risk of seizure/epilepsy or major cardiovascular events between TGA lasting < 1 h versus TGA lasting ≥ 1 h., Conclusions: Short-duration TGA episodes (<1 h) were not uncommon and were more frequent than in earlier studies. The clinical features and long-term prognosis of short-duration TGA did not differ from more typical episodes lasting ≥ 1 h., (© 2020 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.)

Background: Reversible cerebral vasoconstriction syndrome (RCVS) is a common cause of thunderclap headache (TCH), mainly recurrent, sometimes associated with seizures and/or neurological deficit. Association with amnesia is exceptional. We report a case series of RCVS concomitant with transient global amnesia (TGA) and propose pathophysiologic hypotheses., Methods: We retrospectively reviewed clinical and radiological features of patients diagnosed with confirmed concomitant RCVS and TGA between 2012 and 2018 in two specialized institutions., Results: Two women aged 67 and 53, and a 64-year-old man had a first thunderclap headache triggered by an acute emotional stress, rapidly followed by TGA. Amnesia resolved within a few hours and RCVS was proven for all, with complete resolution of vasospasms within 3 months. All three patients had excellent outcome., Conclusions: RCVS and TGA can occur simultaneously, which suggests common mechanisms such as aberrant responses to physical or emotional stress and cerebral vasoconstriction.

Background: To analyse whether patients with transient global amnesia (TGA) have concomitant cardiac injury by assessing clinical symptoms, as well as blood and cardiologic test results., Methods: In this retrospective observational study, we analysed 202 consecutive patients presenting with isolated TGA and treated at our institution between March 2010 and December 2018. We examined the incidence of high-sensitivity cardiac troponin I (hs-cTNI) level elevation, electrocardiogram (ECG) findings, and data on clinical management., Results: Among the TGA patients, 17 (8.4%) exhibited elevated levels of hs-cTNI. Although none of the patients had ST elevation, 12 (6.7%) showed QTc prolongation and 11 (6.1%) an inverted T wave on ECG. No typical clinical symptoms suggestive of myocardial infarction were present in any of the cases, however, 17 (8.4%) patients complained of mild somatic symptoms. Patients with hs-cTNI level elevation had a significantly greater likelihood of a history of coronary heart disease (p = 0.03) and a significantly shorter TGA duration at presentation (p < 0.01). Of the 17 patients with hs-cTNI elevation, Takotsubo syndrome was diagnosed in 2, while in the remaining 15 hs-cTNI level elevation remained unresolved. A literature review indicated the female predominance for the occurrence of cardiac involvement in TGA., Conclusions: Although the in-hospital outcomes appear favourable in all cases reported thus far, we believe that all patients with TGA should be carefully evaluated for potential underlying cardiac involvement and comorbidity. Further research on cardiac vulnerability in TGA should attempt to develop a diagnostic algorithm and assess the potential causes of cardiac injury in TGA.

We describe a 68-year-old woman who had typical absence seizures since 14 years of age. The absences were refractory to treatment and persisted into adulthood, with no seizure-free periods until seizure control at 59 years of age. After six years of being seizure-free, she presented with an episode characterized by mental confusion, abnormal behaviour, and amnesia, lasting for several hours. An EEG performed the day after, when the patient had already recovered, was unremarkable. The episode was interpreted as transient global amnesia. After two and three years, respectively, she presented with two analogous episodes lasting >24 hours. An EEG disclosed, on both occasions, subcontinuous generalized spike-and-wave discharges, consistent with absence status epilepticus (AS). The last episode occurred at 68 years of age and was successfully treated with intravenous lorazepam. After one month of follow-up, no further episodes occurred. AS is common in juvenile absence epilepsy, however, our patient showed a rather atypical course, characterized by refractory and persistent absences during adolescence and adulthood, and a tendency for AS to recur with no more absences in later life. Despite the known epilepsy history, AS episodes were initially misdiagnosed. Moreover, EEG recording and subsequent treatment were not performed until the second day of status.

Objective: Transient epileptic amnesia (TEA) is an underestimated condition in emergency clinical setting, where most of transient amnesic episodes tend to be classified as transient global amnesia (TGA). We designed this study to evaluate the actual frequency of TEA in a real-life scenario and to highlight the features that can help clinicians distinguishing it from TGA., Methods: We retrospectively collected clinical data of 83 patients who accessed our emergency ward for an abrupt onset of amnesic disorder, initially interpreted as TGA. All patients underwent neurological evaluation, magnetic resonance imaging (MRI) scan, and standard 21-channel scalp electroencephalography (EEG) recording (standard EEG [st-EEG]). Moreover, patients with borderline epileptiform abnormalities on st-EEG or with normal st-EEG but high clinical suspicion for TEA underwent a 16-channel 24-hour ambulatory EEG (24-h EEG). Clinical features, neurophysiological, and neuroimaging data were analyzed and compared in the two groups (TEA and TGA)., Results: Diagnosis of TEA, according to Zeman's criteria, was made in 15 patients (18%). From a clinical point of view recurrence (p < .001) and atypical symptoms such as confusion or language disorder (TGA plus manifestations), appear to be key elements in order to discriminate between TEA and TGA (80% of patients with TEA vs 7.8% of patients with TGA; p < .001). In our sample, duration of the episodes did not significantly differ between TGA and TEA, even though it is usually described as shorter for TEA. This result could be related with a prolonged postictal state in these patients. The analysis of st-EEG results evidenced low sensitivity for interictal epileptiform abnormalities (IEAs) detection (52.3%), with not conclusive data in distinguishing TEA from TGA. On the contrary, 24-h EEG showed IEAs in all patients with epilepsy, mostly during sleep, suggesting an essential diagnostic role of long-lasting EEG recording for TEA. Finally, structural abnormalities were more frequent in patients with TEA (26.6%). In the group with TGA, the only imaging alteration found was diffusion weighted imaging (DWI) hippocampal hyperintensity., Conclusion: Our findings show that in a real-life clinical scenario, TEA is frequent but often overlooked. However, simple clinical data and widely available neurophysiological examinations can truly help to effectively distinguish TEA from TGA., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Clinicians are often confronted with patients who have transient neurologic symptoms lasting seconds to hours. In many of these patients, their symptoms have gone away or returned to baseline by the time of evaluation, making the diagnosis even more challenging. Elements such as correlation of symptoms with vascular territory, prodromes, triggers, motor symptoms, confusion, and sleep behavior can guide the diagnostic workup., (Copyright © 2018 Cleveland Clinic.)

Whole-body cryotherapy (WBC), which consists of a short exposure to very cold and dry air in special 'cryo-chambers', is believed to reduce inflammation and musculoskeletal pain as well as improve athletes' recovery. This is the case of a 63-year-old male, who presented with transient global amnesia (TGA) after undertaking a WBC session. TGA is a clinical syndrome characterised by a sudden onset of anterograde amnesia, sometimes coupled with a retrograde component, lasting up to 24 hours without other neurological deficits. Even though the patient completely recovered, as expected, in 24 hours, this case highlights that WBC is potentially not as risk free as thought to be initially. To conclude, before WBC can be medically recommended, well-conducted studies investigating the possible adverse events are required., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Epileptic seizures can manifest with a variety of clinical symptoms. Depending on the dominant symptom, several differential diagnoses have to be considered. Their differentiation can be challenging, especially after the first episode. The review article summarizes the most common differential diagnoses as well as their characteristics compared to epileptic seizures, aiming at providing guidelines for their clinical differentiation. Whenever a clear diagnosis is not possible based on the patient history and clinical signs, diagnostic evaluation with, e. g. an electroencephalogram (EEG) and finally EEG video monitoring can be helpful.

Takotsubo cardiomyopathy (TTC) is associated with acute, reversible left ventricular (LV) dysfunction, while transient global amnesia (TGA) is a reversible disorder of the brain characterised by anterograde amnesia. We report an unusual case of TTC occurring concurrently in a patient with TGA, and propose that catecholamine surge induced cerebral venous congestion and cardiotoxicity is the shared aetiology that leads to the concurrent manifestation of these conditions. TTC and TGA are reversible disorders that can occur concurrently in a subset of patients due to a unifying aetiology, catecholamine excess, leading to pathophysiological changes within the brain and the myocardium., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Introduction: Transient Global Amnesia (TGA) is short-term inability to form new memories despite otherwise normal neurological function. There is associated anterograde and retrograde amnesia. The memory loss is often accompanied by repetitive questioning and temporal disorientation while higher cognitive functions are preserved. The symptoms usually resolve by 24h., Case Report: We present an interesting case of 31year old female who was planned for robotically assisted right sided pyeloplasty. 30min after emergence from anaesthesia patient was disoriented, with retrograde and anterograde amnesia, but neurological function was intact. Neurologic imaging revealed no abnormality. 36h later patient was able to recall everything., Discussion: The pathogenesis of TGA has more recently been attributed to cerebral venous hypertension resulting from retrograde jugular venous flow. Precipitating events are Valsalva manoeuvre, emotion/stress/pain, Excessive exertion, sexual intercourse and swimming in cold water., Conclusion: TGA presents dramatically, it needs to be differentiated from cerebral event. It resolves on its own. But one needs to be aware of existence of such an entity., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Transient epileptic amnesia (TEA) is a sub-type of mesial temporal lobe epilepsy, with amnesic seizures. TEA is characterized by recurrent episodes of amnesia. Diagnostic criteria are available for TEA, and these memory disturbances should not be misdiagnosed with transient global amnesia. The neuropsychological evaluation is normal, however, autobiographical memory impairment is present in 70% of the cases and accelerated long term forgetting in 44%. When a patient complains of memory disturbances, especially autobiographical memory, TEA must be considered especially if there was an amnesic episode and symptoms that suggest temporal epilepsia. Video electroencephalography monitoring of sleep is a precious diagnostic tool, as epileptiform activities are found during sleep in 83% cases. TEA is pharmaco-sensitive, with full treatment response in 73 to 96% of the cases., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)