The patient seemed not to understand what his wife said to him, at least he paid no attention except for simple commands. Regarding the change in speech that was to develop later, his wife did not notice any word-finding difficulty at the time of the attack or since. At first he continued to tend to his flowers but gave that up after 2 years as he no longer could plan the planting or arrange the rows. His wife thought that if she took him to a wedding at that point, he would not act much differently than he had 4 years ago. He had not changed a great deal in the 4 years since the initial episode. He could go out to dinner and go visiting without attracting attention. He did not smoke, drank very occasionally, and took no medication.Īfter the onset of the amnesia he was able to carry on a rambling, superficially plausible conversation. He could briskly ascend 5 flights of stairs. He read widely and was interested in everything. Friends were amazed at his physical stamina and mental keenness. Prior to the episode he had been remarkably well. In a few seconds, 60 years of his life were eliminated from his memory.
Almost from the time of onset, he began to say, "I think we'd better go home" this became the most prominent of several stereotyped utterances ever since. Occasionally he might recognize his wife as a familiar figure and ask her where his wife was. He did not recognize his home where he had lived for 38 years. He never spoke of his wartime service or his years as a teacher and political activist. In the following days the patient talked about his boyhood days on the family farm in Minnesota and his love of horses. There had been no injury, headache, weakness, slurred speech, change in color, dizziness, imbalance, impaired alertness, jerking, incontinence, facial asymmetry, or visual complaint. In the next several minutes she became aware that her husband had lost his memory of his family, longtime friends, his whereabouts, and his entire career. He sought out the conductor who brought the patient back to his train car where he did not recognize his wife. He taught and translated French, German, and Spanish.įour years before, at the age of 80 years, while traveling by train to Cleveland, Ohio, with his wife to attend a wedding, he suddenly announced that the conductor did not know where he was going and he wanted to get off the train. Earlier he had served on wartime duty as an army officer. The patient had had a distinguished career in academia. Because he could give no medical history, it was provided by his devoted wife of 38 years who was intelligent and objective. The patient, a retired professor of mathematics and languages, was first examined at the Massachusetts General Hospital, Boston, when he was 84 years old. It is likely that rare cases of amnesia occur as the result of an unrecognized pathophysiologic process. Magnetic resonance imaging 10 years from the onset showed abnormality of the medial temporal lobe bilaterally.Ĭonclusions In neither case was the amnesia satisfactorily explained. There was no progression of the disabling amnesia in the next 15 years. In the second case a disabling amnesia developed overnight in a man aged 70 years. Neuropathologic study 5 years later showed the changes of Alzheimer disease. Results A man aged 80 years suddenly lost his memory of the previous 60 years. In 1 case, a neuropathologic study disclosed Alzheimer disease in the other, magnetic resonance imaging showed a temporal lobe abnormality bilaterally. Patients and Methods In a clinical study, 2 elderly men are described in which sudden, permanent amnesia developed in the absence of a satisfactory explanation. Ischemic stroke, hypoglycemia, syncope, and seizure are the most likely causes. Shared Decision Making and Communicationīackground In almost all cases of acute, sudden, persistent amnesia, the cause can be determined.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.
Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
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