AMNESIA

Ask the following questions:

1. Is the amnesia transient or persistent? If it is transient, one should look for evidence of a head injury. If there is no evidence of a head injury, then one should consider epilepsy, transient ischemic attacks, and migraine. If there is evidence of a head injury, one would consider concussion and some of the other more serious conditions of the brain that occur with a head injury.
2. Is there a fever? If the amnesia is persistent and there is a fever, one needs to consider encephalitis, meningoencephalitis, cerebral abscesses, and encephalomyelitis. If there is no fever, one must ask if there is a reduction of memory for recent events. If there is reduction of memory for recent events, one should consider some of the more serious diseases of the brain, such as cerebral tumors, chronic drug or alcohol use, Alzheimer's disease, cerebral arterial sclerosis, and neurosyphilis. If there is no reduction of memory for recent events, then a psychiatric disorder such as hysteria, dissociated reaction, or schizophrenia must be considered.

DIAGNOSTIC WORKUP

All patients with a history of amnesia deserve a CT scan or magnetic resonance imaging (MRI). The CT scan would be more cost-effective and would be the diagnostic test of choice because it also helps detect acute brain hemorrhages. Patients with fever should have a spinal tap as well as CBC, urinalysis, and chemistry panel. These patients also probably should have a blood culture. An electroencephalogram (EEG) should be ordered to rule out epilepsy and toxic metabolic inflammatory diseases of the brain.

If all these studies are negative and an organic cause is still considered, then referral to a neurosurgeon or neurologist is in order. If these studies are negative and a psychiatric disorder is suspected, a psychiatrist should be consulted.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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