[Differential diagnostic question: traumatic unconsciousness or amnestic episode?]

Abstract

Traumatic twilight state on the one and amnestic episode (transient global amnesia) on the other side are as a rule easy to differentiate from the patient's age, his behavior during the acute state of disease and the kind of its improving. Contrary to other authors' opinion, differentiation is not just possible by diagnosing an injury or its absence. In minor skull traumata preceding the traumatic twilight states injuries are often not manifest and otherwise amnestic episodes occasionnally occur after minor traumata. In a 64 years old woman an obviously typical amnestic episode appeared in direct connection with a probable fall on the back of the head. A 28 years old man underwent a five-hour amnestic episode whereas the EEG showed normal curves. The episode occurred 15 minutes after striking hard upon the ground with the back of the head during a ground roll without following unconsciousness. In both cases traumatic twilight states were not involved. In account of the interval of 15 minutes the trauma of the second case seems not be be the direct cause for the manifestation of amnestic episode. It also shows that the aspect of the disease in the rare occurrence in younger or middle-aged persons is on principle not different from that in old ones. Since a special medical examination during the acute state is only possible as exception the patient's amnestically seizable behaviour obtains greatest importance in differential diagnosis. For the rare coincidence the trauma is given no pathogenetic relevance in amnestic episodes.