(Disclaimer: This article is for scientific use only, and the information in the following content has been processed to protect patient privacy)
Abstract: Amnesia mainly consists of prograde amnesia and retrograde amnesia, which is accompanied by altered memory function. The most important anatomical structure is the hippocampal region of the temporal lobe, and the integrity of hippocampal structures and the dorsal thalamic nucleus is essential for normal memory and learning functions. This case is mainly an amnesia caused by a new punctate cerebral infarction in the medial aspect of the temporal lobe. The patient had several episodes of memory loss, and the symptoms improved significantly with medication.
[Basic information] Female, 55 years old
Type of disease】Amnesia
Hospital】The Second Hospital of Harbin Medical University
Date of consultation】January 2022
Treatment plan】Medication (Ginkgo biloba extract injection + piracetam tablets + aspirin enteric soluble tablets)
Treatment period】7 days of inpatient treatment, 2-3 weeks of outpatient follow up
Effectiveness of treatment】Symptoms of memory loss are relieved
I. Initial interview
The patient had episodes of memory loss 20 days before admission without any obvious cause, manifested as inability to remember what she ate for breakfast at night and to remember where she had been in the afternoon, with 5 episodes in 20 days, each lasting about half an hour to relieve, no memory loss of her name, residence, names of relatives, phone numbers of others, no limb weakness, upper limbs can be lifted, lower limbs can walk, no headache, no dizziness, no nausea and vomiting, no dizziness and no vomiting. The patient’s family brought him to the clinic for this reason. After admission, the patient completed head MRI, biochemical series, blood homocysteine and other tests.
II. Treatment history
The patient’s physical examination after admission showed good general condition, and the specialist examination showed clear consciousness, bilateral pupils with equal circle, diameter about 3.0mm, normal memory, normal muscle strength of the limbs, normal muscle tone of the limbs, negative pathological signs of both lower limbs, head MRI showed multiple ischemic foci in the skull, and head DWI showed punctate new cerebral infarction in the temporal lobe. Combined with the head MRI results and symptoms, the patient was diagnosed with amnesia caused by temporal lobe punctate new cerebral infarction, and the treatment was mainly pharmacological.
III. Treatment effect
This patient was admitted to the hospital with episodic memory loss, and the episodes were relatively frequent. The head magnetic resonance showed cerebral infarction in the medial temporal lobe, and although the infarct area was not large, the ischemia was extensive, causing insufficient perfusion to the whole brain. Through drug treatment, the patient’s memory loss symptoms were relieved during the 7-day treatment cycle, and at the time of discharge, the patient had no further seizures, clear consciousness, no limb numbness and weakness, and the patient’s general condition was better than before. The patient continued antiplatelet, cognitive function improvement and lipid regulation treatment, and was granted discharge, and was instructed to follow up regularly in the outpatient clinic for 2-3 weeks and adjust the dosage of antiplatelet drugs after physical examination.
IV. Notes
I was happy to see that the patient’s symptoms improved and he was happily discharged from the hospital. After discharge, I advised the patient to pay attention to his lifestyle, quit smoking and drinking, exercise properly, and pay attention to rest and sleep. As the patient may not be able to find his way home, not remember what he is doing, not recognize his relatives and friends, usually accompanied by unilateral or bilateral hemianopia, visual loss, naming inability, etc., and because the patient’s limb activity function is not impaired, the condition may be accidental during the attack, so the family must pay attention to watch over the patient to prevent getting lost, and need to be accompanied by family members when going out. Pay attention to adjusting the diet structure, quit smoking and alcohol, and go to the hospital for regular review.
V. Personal insight
Amnesia due to punctate new cerebral infarction in the medial temporal lobe is relatively rare. Such patients may also have transient general amnesia, such as the patient in this case, the patient may keep asking about the situation at that time during the attack of the disease, and there is no abnormality in intellectual cognition after the termination of the attack, but only a permanent gulf in the memory, so that the memory of a short period of time between the time of the attack and before the attack is interrupted, and a mild headache will be left behind.