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Transient Global Amnesia and a Father's Worst Nightmare
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     To the Editor: Severe emotional stress can lead to a myriad of somatic or neurologic problems, including transient global amnesia, a syndrome of retrograde and anterograde memory loss without focal neurologic disturbances.1 I report the case of a healthy man who presented with transient, profound anterograde and retrograde amnesia that was precipitated by a disturbing dream.

    A healthy 61-year-old man was brought to the emergency department by his wife after she noticed that he was forgetful of the previous evening's activities and was unable to form new memories during the subsequent day. The patient repeated the same questions and could not remember events minutes after their occurrence. There was no history of intoxication, drug use, head trauma, or obvious physical or emotional stress. He had no medical history other than seasonal allergies and took no regular medications. The physical and neurologic examinations were otherwise normal.

    The patient could not remember seeing the physician in the emergency department or his nurse or how he came to his hospital room. He repeatedly inquired, "Did I have a stroke?" and stated, "I can't remember anything." The following laboratory and radiographic studies were normal: computed tomography of the brain; chest radiography; electrocardiography; a complete blood count; measurement of serum electrolytes and creatinine, liver enzymes, serum ammonia, and cardiac enzymes; urinalysis; and comprehensive screening of the urine for drugs. The next morning the patient still had amnesia with respect to the events of the two previous days.

    On hospital day 2, the patient had a normal mental status and was able to form anterograde memories. He remembered that just before his amnestic episode, he had fallen asleep and dreamed about his son joining the Marines and being killed in combat in Iraq. He vividly saw his son in a casket draped with an American flag. At this point, he screamed and woke up with amnesia. The patient was especially distraught because his son was contemplating joining the military at the time the dream occurred. The episode of transient global amnesia was considered to be due to the stress of the dream, and the patient was discharged.

    Transient global amnesia presumably results from transient dysfunction of the temporal lobes or diencephalon and may arise during coughing, exercise, sexual intercourse, driving, or medical procedures or after severe emotional stress, as in this case.1,2,3 Freud and Breuer described the classic sentinel case of global amnesia in a young woman ("Anna O.") that was precipitated by the death of her father: "The hysterical attack corresponds to a memory from the patient's life."4 Recognition of the stressful event by the patient ameliorates amnestic or somatic symptoms.4 Clinicians need to be aware of the potential effects of emotional trauma on patients' lives and recognize that severe mental stress may be manifested by somatic, psychiatric, or neurologic symptoms, including profound global amnesia. Inquiring about recent nightmares or dreams may be helpful in the evaluation of patients with obscure neuropsychiatric presentations.

    When the patient I describe was last seen at close follow-up, his mental state was fine and his son had not joined the military.

    Mark A. Marinella, M.D.

    Wright State University School of Medicine

    Dayton, OH 45429

    References

    Lewis SL. Aetiology of transient global amnesia. Lancet 1998;352:397-399.

    Hodges JR, Ward CD. Observations during transient global amnesia: a behavioural and neuropsychological study of five cases. Brain 1989;112:595-620.

    Rosler A, Mras GJ, Frese A, Albert I, Schnorpfeil F. Precipitating factors of transient global amnesia. J Neurol 1999;246:53-54.

    Freud S, Breuer J. Studies on hysteria. Strachey J, Strachey A, trans. London: Penguin, 1991.