A 67-year-old man is brought to the Emergency Department, having previously presented to the local police station. He is a lifelong smoker with troublesome gout but otherwise has no past medical or family history. He describes a sudden-onset loss of memory for recent events. He remained alert and was still able to drive to the police station.
He seems perplexed by what has happened to him and continually asks where he is. Neurological examination is unremarkable; there is no evidence of head injury.
Blood testing including biochemistry, urine toxicology and blood inflammatory markers is normal. He is admitted to the ward and a CT brain is performed, which is reported as normal. The next day his memory has improved substantially and he is allowed home.
On follow-up appointment, he admits to mild memory problems for two days post-discharge but now feels his memory is back to normal. He asks for prognostic information.
What is the likely diagnosis?
Transient global amnesia
What is transient global amnesia?
Acute onset of anterograde amnesia (the inability to form new memories)
What is the management of mild to moderate Alzheimer’s?
Acetylcholinesterase inhibitors: donepezil, galantamine, rivastigmine
Second line: memantine - as add on in severe disease or moderate disease with intolerance to acetylcholinesterase inhibitors
When is donepezil contraindicated?
Bradycardia
How would you investigate for Lewy Body dementia?
Single-photon emission computed tomography (SPECT)
What is the treatment of lewy body dementia?
Acetylcholinesterase inhibitors (rivastigmine)
What does the Waterlow score measure?
Patients who are at risk of developing pressure ulcers
What dressing should you use on a pressure ulcer?
Hydrocolloid
