Transient Global Amnesia In A Triathlete

History: A 63yo female presented with acute onset memory loss upon completion of a sprint triathlon. After crossing the finish line, the patient was found by her family, confused as to why she had a finisher medal because she did not remember completing the run and asking repetitive questions. A neurological exam was conducted on-site. She identified Reagan as the current president but otherwise the exam was normal. She is a well-trained age-group athlete with no prior neurologic, cardiac, or thrombotic history and no current medications. There was no evidence of trauma. No history of substance use. No headache, loss of consciousness, No headache, loss of consciousness, vertigo, weakness, palpitations, chest pain, or dyspnea. Physical Examination: HR 89, BP 118/86, Temp 97.6 °F, O2 98%. Alert, cooperative. Oriented to person and place, not time. Anterograde amnesia present with limited retrograde amnesia, otherwise normal neuro exam. CN 2-12, sensation, and strength intact. Negative Romberg. No aphasia or dysarthria. No spatial neglect. No signs of trauma. Pulmonary and cardiac exams normal. Differential Diagnosis: Transient Global Amnesia, TIA/stroke, Seizure, Cardiac-related with anoxia, Delirium Tests & Results: CT head without contrast normal. EKG normal. Glucose 149. CBC, CMP, and urinalysis were unremarkable: Na + 136, K+ 4.1, Cl- 103, Bicarb 22, Mg 2.0, CK 377; Hb 13.5, WBC 9.12. Final/Working Diagnosis: Transient Global Amnesia Discussion: This case demonstrates a rare condition, Transient Global Amnesia, triggered by strenuous physical activity. TGA is a benign, self-limited condition characterized by abrupt onset of anterograde amnesia and "broken-record" phenomenon, with other cognitive functions intact. Episodes resolve within 2-24 hours and strenuous activity is a known trigger. Initial management should focus on ruling out other serious conditions. Treatment & Outcomes: The patient was discharged from the ED following the diagnosis of TGA. The duration of the TGA event was 3 hours. After which time the retrograde amnesia resolved, however, the 2-3 hour memory gap was never recovered. The patient returned to activity a few hours after the event without issue. She has not had a recurrent episode.