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DIAG 2740 Chapter 18 Case Studies

DIAG 2740 Chapter 18 Case Studies - Chapter 18 Cases Case#1...

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Chapter 18 Cases Case #1 Sudden Memory Loss After a Mild Head Injury Minicase A 33 year old neurology resident with a history of migraine fell backward while attempting a ski jump, struck his occiput on the snow, and suddenly developed amnesia. His wife witnessed the incident and reported that he had not lost consciousness from the fall. He stood himself up, skied part way down the slope, and then stopped, telling his wife that he must have amnesia because he did not know the date, where he was, or how he had gotten there. He also reported seeing a scintillating scotoma in the left upper part of his visual field, like that accompanying his typical migraines. At first his wife thought that he was joking around, but when he began asking the same questions repeatedly, it soon became clear that he had a serious problem. He was unable to retain any new information for longer than 1 to 2 minutes. In addition, he did not recall any events that occurred during the previous year, including the fact that his wife was pregnant. Aside from the memory loss, he had no other significant deficits. He was taken to a local hospital, where a head CT was normal , and he was discharged in the care of his wife and friends. Being a neurologist, he constantly urged those around him to test his memory during the long car ride home. Meanwhile he was able to enjoy the exciting news that his wife was pregnant over and over again. Approximately 5 hours after onset, he was finally able to recall three words after a 3-4 minute delay, but this ability was still inconsistent. At about the same time, memories from the previous year began to return gradually, with the most remote memories generally returning first. By the next morning he was able to recall new facts about as well as at a baseline. In addition, he remembered everything from the previous year, except for a period extending from 2-3 hours before the injury to about 5 hours after the injury. An MRI scan performed a few days later was normal. Localization and differential diagnosis 1. On the basis of the signs and symptoms shown above in bold, what type of memory was impaired in this patient? How would you describe the chronological features of this amnesia? Dysfunction in which locations in the brain could produce these findings?
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