Anterograde Amnesia as a Manifestation of Acute Type A Aortic Dissection

Abstract

Objectives Memory impairment has been only rarely reported in association with acute aortic dissection type A. We report a patient with pure anterograde amnesia and memory impairment of contents occurring after the event, accompanying acute aortic dissection type A.

Case Report A previously healthy 53-year-old Caucasian male was admitted because of sudden chest pain after having lifted a heavy object. Clinical examination and electrocardiogram showed no abnormalities. Since blood tests showed leukocytosis, anemia, and elevated D-dimer level, either pulmonary embolism or aortic dissection was suspected; therefore, computed tomography was suggested. The patient seemed disoriented to time, and neurologic investigation confirmed that the patient was disoriented to time; short time memory was severely impaired and concentration was reduced. An amnestic episode with anterograde amnesia was diagnosed. Computed tomography showed type A aortic dissection. A supracoronary replacement of the ascending aorta was performed. The patient was discharged on the 7th postoperative day. Three months postoperatively, the patient is clinically stable; however, amnesia for the interval between pain onset and cardiac surgery persists.

Conclusions Transient amnesia, usually considered a benign syndrome, may be more common than generally recognized in aortic dissection. The suspicion for aortic dissection or other cardiovascular emergencies is substantiated when amnesia is associated with sudden onset of chest pain, leukocytosis, and elevated D-dimer levels. Computed tomography of the aorta with contrast medium is the imaging method of choice to confirm or exclude the diagnosis.

Keywords

aortic dissection - transient global amnesia - chest pain

Publication History

Article published online:
05 July 2019

• References

• 1 April MD, Fossum K, Hounshell C, Stolper K, Spear L, Semelrath K. A sinister cause of anterograde amnesia: painless aortic dissection. Am J Emerg Med 2015; 33 (07) 989.e5-989.e7
• 2 Bonnet P, Niclot P, Chaussin F, Placide M, Debray MP, Fichelle A. A puzzling case of transient global amnesia. Lancet 2004; 364 (9433): 554
• 3 Colotto M, Maranghi M, Epifania A, Totaro M, Giura R, Durante C. Unmasking aortic dissection in patients of transient global amnesia: case report and diagnostic algorithm for the emergency department. BMJ Case Rep 2011; 2011: bcr0720103151
• 4 Gaul C, Dietrich W, Tomandl B, Neundörfer B, Erbguth FJ. Aortic dissection presenting with transient global amnesia-like symptoms. Neurology 2004; 63 (12) 2442-2443
• 5 Kaveeshvar H, Kashouty R, Loomba V, Yono N. A rare case of aortic dissection presenting as pure transient global amnesia. Cardiovasc J Afr 2015; 26 (06) e8-e9
• 6 Mondon K, Blechet C, Gochard A. et al. Transient global amnesia caused by painless aortic dissection. Emerg Med J 2007; 24 (01) 63-64
• 7 Rosenberg GA. Transient global amnesia with a dissecting aortic aneurysm. Arch Neurol 1979; 36 (04) 255
• 8 Hodges JR, Warlow CP. Syndromes of transient amnesia: towards a classification. A study of 153 cases. J Neurol Neurosurg Psychiatry 1990; 53 (10) 834-843
• 9 Saker E, Nguyen J, Vyas N. Transient global amnesia: minor inconvenience or early warning sign?. J Saudi Heart Assoc 2018; 30 (04) 297-300
• 10 Spiegel DR, Smith J, Wade RR. et al. Transient global amnesia: current perspectives. Neuropsychiatr Dis Treat 2017; 13: 2691-2703
• 11 Lewis SL. Aetiology of transient global amnesia. Lancet 1998; 352 (9125): 397-399
• 12 Modabbernia A, Taslimi S, Ashrafi M, Modabbernia MJ, Hu HH. Internal jugular vein reflux in patients with transient global amnesia: a meta-analysis of case-control studies. Acta Neurol Belg 2012; 112 (03) 237-244
• 13 Mussa FF, Horton JD, Moridzadeh R, Nicholson J, Trimarchi S, Eagle KA. Acute aortic dissection and intramural hematoma: a systematic review. JAMA 2016; 316 (07) 754-763