Hippocampal infarction
Yuhei Uriu, Akira Kuriyama ‍ ‍
Emergency and Critical Care
Center, Kurashiki Central
Hospital, Kurashiki, Japan
Correspondence to
Dr Akira Kuriyama, Emergency
and Critical Care Center,
Kurashiki Central Hospital, 1-1-1
Kurashiki 710-8602, Japan;
​ak13568@​kchnet.o​ r.​jp
Received 5 September 2019
Accepted 30 September 2019
Published Online First 10
October 2019

An 85-­year-­old man presented with acute confusion. He had chronic atrial fibrillation but was not
taking anticoagulants. He was disoriented and had
no recollection of the past 2 days. He had no history
of physical or emotional stress, recent head trauma
or seizures. On examination, he was disoriented to
time, scored 14 on the Glasgow Coma Scale (E4,
V4 and M6) and lacked focal neurological deficits.
Serum glucose levels, electrolytes and thyroid function were normal. MRI revealed a high-­intensity
diffusion-­
weighted sequence in the left hippocampal region (figures 1 and 2). A diagnosis of
hippocampal infarction was established.
Transient global amnesia (TGA) usually affects
Figure 2 MRI revealed a high-­intensity diffusion-­
individuals aged 50–80 years and is characterised
weighted sequence in the left hippocampal region on the
by sudden-­onset anterograde amnesia that resolves
coronal view.
within 24 hours. Certain events often precede its
1
attack. In contrast, isolated hippocampal infarctions are rare, accounting for 0.03% of first-­ever secondary prevention for hippocampal infarctions,
ischaemic strokes.2 Hippocampal infarctions whereas only observation is required for TGA.
Given that both conditions develop later in life,
are associated with persistent anterograde-­
to-­
require different therapeutic approaches and occaretrograde amnesia, as well as altered mental status
sionally have similar presentations, it is important
2
and confusion. A case–control study suggested that
to exclude ischaemic events before diagnosing
cardiovascular risk factors including hypertension,
TGA. MRI is useful.
diabetes mellitus and atrial fibrillation are more
We initiated anticoagulation treatment, and the
prevalent in transient ischaemic attacks than in
patient’s
short-­term memory recovered in 5 months.
TGA.3 Furthermore, the treatments differ; anticoagulants or antiplatelet agents are indicated as the Contributors YU and AK looked after the patient, wrote and
critically revised the manuscript, and approved the submission of
the current manuscript. AK served as the guarantor for this article.
Funding The authors have not declared a specific grant for this
research from any funding agency in the public, commercial or
not-­for-­profit sectors.
Competing interests None declared.
Patient consent for publication Obtained.
Provenance and peer review Not commissioned; internally peer
reviewed.
ORCID iD
Akira Kuriyama http://​orcid.​org/​0000-​0002-​6633-​7816

References

© Author(s) (or their
employer(s)) 2020. No
commercial re-­use. See rights
and permissions. Published
by BMJ.
To cite: Uriu Y, Kuriyama A.
Postgrad Med J
2020;96:166.

166

Figure 1 MRI revealed a high-­intensity diffusion-­
weighted sequence in the left hippocampal region on the
transverse view.

1 Spiegel DR, Smith J, Wade RR, et al. Transient global amnesia: current
perspectives. Neuropsychiatr Dis Treat 2017;13:2691–703.
2 Kumral E, Deveci EE, Erdoğan C, et al. Isolated hippocampal
infarcts: vascular and neuropsychological findings. J Neurol Sci
2015;356:83–9.
3 Jang J-­W, Park SY, Hong J-­H, et al. Different risk factor profiles
between transient global amnesia and transient ischemic attack: a
large case-­control study. Eur Neurol 2014;71:19–24.

Uriu Y, Kuriyama A. Postgrad Med J 2020;96:166. doi:10.1136/postgradmedj-2019-137114

Postgrad Med J: first published as 10.1136/postgradmedj-2019-137114 on 10 October 2019. Downloaded from http://pmj.bmj.com/ on April 10, 2020 at University of Birmingham. Protected
by copyright.

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