Transient Global Amnesia in a Young Woman on Prolonged Treatment with Oral Contraceptive Drugs

Transient global amnesia (TGA) is a generally benign syndrome lasting less than 1 hour characterized by sudden loss of anterograde and retrograde memory and repetitious queries in the absence of changes of the personality and of detectable neurological signs. This paper reports the case of a 41-year-old woman who developed two episodes of TGA in June 1994. During a sustained more than 6-month treatment with an estrogen/progestogen association containing 20 mg of ethinylestradiol and 150 mg of desogestogen the woman experienced a sudden onset of spatial disorientation and of retrograde and anterograde amnesia. During the attack she experienced neither speech disturbance nor features suggestive of epilepsy. After approximately 40 minutes the womans memory gradually returned to normal and she had no memory of her amnesic episode. A second shorter episode of memory loss occurred 15 minutes later. The womans clinical summary was negative for major risk factors for cerebrovascular disease and she had no history of seizures migraine or head injury. Her physical examination was normal as were her EEG ECG two-dimensional echocardiography Doppler ultrasound of the carotid and vertebral arteries and brain nuclear magnetic resonance. Liver and kidney functions were normal as were antiphospholipid antibodies and protein C levels. However functional antithrombin III was 77% protein S was 60% and n-APC-ratio was 0.78. These hemostatic test values returned to within normal levels 2 months after discontinuation of the drug. 15 months following the end of administration of the drug the patient had yet to experience another episode of TGA.