Transient global amnesia in legal proceedings

Abstract

Transient global amnesia (TGA) is a neurological disorder characterized by an acute onset of severe anterograde amnesia. While retrograde amnesia may be present-although to a lesser extent-patients have no further cognitive disturbances or neurological signs. These symptoms resolve fully within several hours leaving a permanent memory gap for the duration of the episode and do not lead to long-term neurological deficits. In addition to well-defined clinical diagnostic criteria, in up to 80 % of patients, small, point-shaped lesions in the hippocampus are detected 24-48 h after symptom onset on diffusion-weighted magnetic resonance images. Despite several etiological hypotheses, to date, there is no scientific proof for the etiology of TGA or the small hippocampal lesions. Interestingly, in a large number of cases, an emotionally or physically straining event precipitates the onset of TGA, suggesting a stress-related mechanism. We report two cases of TGA occurring in legally relevant settings: affecting the victim of brutal burglary and the key witness in a murder trial. In the context of forensic medicine, the knowledge of this disorder and recognition of its typical features are essential.

Stronger Pharmacological Cortisol Suppression and Anticipatory Cortisol Stress Response in Transient Global Amnesia

“…As more recently analyzed, in up to 90% (32–89.1%) of reported TGA cases, a precipitating event – mainly described as physical, emotional, or behavioral stress – has been reported (Quinette et al, 2006 ). In addition to those mentioned above, typical such events include stressful medical examinations, arguments, legal proceedings, funerals, exhausting physical work, and celebrations (Schmidtke and Ehmsen, 1998 ; Quinette et al, 2006 ; Griebe et al, 2015 ). In addition to events immediately before the attack, remote factors preceding TGA by days or weeks, for example, anxiety, exhaustion, and financial worries have also been described (Quinette et al, 2006 ).…”

Neue Aspekte zur Pathophysiologie der transienten globalen Amnesie

“…Die klinische Phänomenologie der TGA ist schon seit den 60er-Jahren im Detail anhand zahlreicher Kasuistiken beschrieben [3,4], allerdings werden immer noch zahlreiche Fallbeispiele veröffentlicht, die die Faszination dieser Störung in der klinischen Neurologie widerspiegeln. Als Beispiel sei eine Fallserie erwähnt, die die juristischen Implikationen der TGA anhand zweier Fälle beschreibt [5] (siehe Kasuistik). Diese Beschreibungen ergänzen die im Kontext der forensischen Medizin bekannten Formen der amnestischen Störungen, insbesondere die dissoziative Amnesie.…”