Intermittant Short Term Memory Loss

[Bill Meade]

Here is the current mailbox of responses to the message I put on   
bionet.neuroscience (this is a net news group you might be interested in   
subscribing to).  I've arranged them chronologically and omitted some of   
my own responses.  Note, one additional fact that has come up in the   
course of reviewing these with Beth is that when she is awake and has a   
mild attack she becomes nauseus so there are symptoms besides the memory   
loss itself.  Beth is working on a timeline of these events that I will   
post later.  Thanks for your time!   
 
In article <3n4lqg$9vi at kasey.umkc.edu> you wrote: 
:My wife (age 34) has had intermittant loss of short term (i.e., the last 
:two weeks of events when it happens) memory for the past 12 years. 
:Frequency is about once every 8 months (sometimes once a year others 
:once a month).  In the past 5 years she's had a CatScan, EEG (had the 
:memory loss while on the EEG machine the first time but no symptoms were 
:picked up) twice, and one year ago she had an MRI.  MRI showed some 
:shrinkage around the  brain stem (in the neurologist's words) but   
nothing 
:else major. 
: 
:She had another episode 3 weekends ago.  It happend (as is often the 
:case) while she was taking a short nap.  She wakes up not knowing what   
:is going on (not disoriented just no memeories).  It looks for all the  
:world like a hard disk is being decheckerboarded and is interrupted in 
:the middle.  All the pointers are gone and have to be rebuilt.  In  
:about 24 hours she is back to normal and the memories are back except 
:for a few fuzzy facts (she reviews shopping lists etc. to nail down as 
:many details as possible).  Only drug she is on is birth control  
:pills.  We have 3 kids under 10 and are under no huge stresses.   
:Yes, we called the neurologist about this but he had no new ideas. 
: 
:If anyone has any ideas I would appreciate it if you would contact me 
:and let me know.  We're at a loss about where to go next and have  
:gone into "broacast mode" to avoid overlooking any simple cures that 
:might exist. 
: 
: Bill Meade sbmeade at umslvma.umsl.edu 
 
Before a simple cure is found, the diagnosis must be demonstrated. And, 
I find myself somewhat stumped about this. I am assuming her neurological 
exam is normal and additional blood studies and past medical history are 
likewise normal. I am also assuming that these episodes do not always 
follow waking up from sleep. You do not mention any features of her 
memory loss; however, I am  wondering if it clinically fits transient 
global amnesia [TGA], a condition that usually results in the person   
having memory problems and being somwhat bewildered for several hrs, but   
always reversible within 24 hours [see Fischer C, Adams R. Acta Neurol   
Scand 40, suppl 9, 1: 1964; Hinge H-H et al, Arch Neurol, 43, 673, 1986;   
Hodges J, Ward C. Brain, 112, 595, 1989; Hodges J, Warlow C. Brain, 113,   
639, 1990]. 
 
The cause of TGA is unknown but presumed to be transient decreased blood 
flow to the hippocampal region of the brain, involved in memory. These 
articles can be looked up in your nearest medical library. TGA typically 
occurs in older persons and is only rarely recurrent, but we are dealing 
with something atypical in your wife's situation. Unless she has seen 
countless specialists, it is also a good idea to get another opinion from 
a neurologist who specializes in neurobehavioral disoders [e.g. cognitive 
impairment]. The temporal relationship to sleep also makes one wonder 
whether this is a peculiar sleep-related problem [out of my area], and 
this should be evaluated as well by a sleep disorders specialist if the 
consulting neurologist is not able to come up with a diagnosis. 
 
Please recognize that I do not have all the clinical and lab info, and my 
thoughts about this are speculative...... 
 
Regards, Lyn Frumkin, MD [neurology] 
 
---- Next Post  
This sounds a little like the woman who had a stroke at 16 and recovered, 
got married, had three children, and then had her next stroke at 34. 
Surgery was used to repair the last broken blood vessel.  While doing his 
they noticed the first stoke damage sight and fixed it also.  When she 
woke up she thought she was 16 and had lost her memory from 16 to 34. 
Your hard drive model and pointer theory sounds interesting.  The 
brain may use time cycles and time dates for information storage.    
Problems with a "clock" system may cause the observation.  Notice in the   
first example that blood flow was reestablished to an old stroke sight,   
the birth control pills may be changing the blood flow patterns and   
result in unusual brain oscillation pattern with no appropriate time   
pointers. This is speculation at best and all usual disclaimers apply. 
Ron Blue x011 at lehigh.edu 
 
--- Which Ron follwed with  
 
If you are interested in theoretical justification of my reply I can 
send you a 78k file by email.  Enclosed is an abstract.  Ron Blue 
x011 at lehigh.edu 
 
Abstract: 
 
The correlational opponent-processing theory is a homeostasis 
integration psychological immune theory that would connect phenomena 
such as sensation, perception, habituation, memory, representations, 
learning, cognition, personality, psychopathology, paradoxical 
integration, emotion, and evolution of the mind under a unified theory. 
 
Perception/learning/cognition may be viewed as an effort to assimilate 
and accommodate all experience into neuro-energy-efficient quasi- 
holographic correlational opponent-processing recordings. 
 
Stimuli causes brain wave modulations which interact with carrier or 
reference wavelets.  This interaction creates a quasi-holographic 
stimulus wavelet.  The opponent-process creates an opposing quasi- 
holographic memory wavelet.  Through this process the correlations or 
associations of experience are encoded to memory.  Every wavelet, 
regardless of source or type, triggers an opposing wavelet.  The 
function of the opposing wavelet or feedback is to diminish the 
intensity of neural processing.  A wavelet potential is stored or hard 
wired as long-term potentiation opponent-processes in nerve cells and 
the interconnections between nerve cells.  The wavelets are quasi- 
holographic and allow recovery of information due to the interaction of 
reference carrier wavelets and stimuli, thought, motor movement, and 
emotional arousal. 
 
Outline: 
       Discussion 
       Neuro Net 
       Quasi-holographic wavelets 
       Habituation/immunization 
       Memory 
       Representations, copies or models 
       Learning/Cognition 
       Personality 
       Sensations and Perceptions 
       Movement 
       Emotion 
       Evolution 
       Tools 
       Implications 
       Conclusion and applications from COP theory 
            Discorrelation 
            Education 
            Biophysical 
            Intelligence 
            Defense Mechanisms 
            Brain damage 
            Creativity 
            Brain Tape 
            Computer Model 
            Conclusion 
       Bibliography 
       Acknowledgments 
 
--- Next response that came in ...  
 
Subject:     Re: Fwd: A shot in the dark ... 
Received:    4/13/95 9:50 PM 
From:        Kathryn Henkens, 70731.2150 at compuserve.com 
To:          Guy Kawasaki, kawasaki at radiomail.net 
 
This is a message I'm "narrowcasting" (like to the bio.neuroscience   
group) about a problem my Beth is having.  Let me know if it sparks any   
pointers.  
 
Guy, all I can add to any comments you send this guy is that I had an 
aunt who died of brain cancer. She had some seizures and was negative on 
all her scans. They told her it was epilepsy and stopped scanning her. By 
the time they found the tumor it was way too late. Tell him to be 
agressive in how he consumes health care. 
 
---- The next post was a bunch of questions from Neal Prakash   
<nprakash at meded.com.uci.edu> his questions have the > in front and our   
responses don't.  (Duh). 
 
>i have a couple more questions... 
> 
>1) is there anything that happened to her 12-13 years ago, ie trauma, 
>concussion, travel to a foreign country, etc.? 
 
Not off the top of my head but I'll ask Beth and see what she can come up   
with. 
> 
>2) what is her average alcohol consumption? 
 
Zero.  Her dad is one of the "yellow ribbon babies" whose parents vowed   
that would never consume alcohol and she seems to have inherited an   
inability to drink the stuff.   
 
>3) are there any other sensations associated with the amnesia?--you said 
>it often occurs when she takes naps, any other particular times? 
> 
>4) any family history of similar problems? 
 
None that we know of. Beth's grandfather was quite senile (age 90+) for   
several years before he died.   
> 
>it sounds like some kind of seizure, but the fact that the EEG was 
>negative during one of these episodes tends to rule that out. 
 
Precisely what I was thinking.  This last time she came down into my   
office and sat down and said, "It's happening again."  and was very   
cogent during the event which seems "unseizurelike" to me.  The first eeg   
she had she had the memory loss while she was on the machine.  When the   
test was over she was in a state of confusion about why all the wires   
were attached to her.   
 
---- The next post was another generous response from Lyn Frumkin 
 
First, let me comment on the other opinions of the replier above. I 
assume that obvious things such as CNS infection from travel to a foreign 
country, amnesia secondary to head trauma, etc have been assessed, as has 
simple partial or partial complex seizures. Has she had a lumbar puncture 
[spinal tap]?   
 
> How many opinions is reasonable in your opinion?  At what point is it 
> reasonable to just live with the problem (if at all)? 
 
This totally depends on who has evaluated her and what their subspecialty 
is. I do not know how she has seen. My impression is that it is never 
adequate to just "live with this" in the absence of a diagnosis. Someone 
will be able to define the problem -you just need to find that person. 
> > 
> >from a neurologist who specializes in neurobehavioral disoders  
> >[e.g. cognitive impairment]. 
> 
> Is there an association/listserv/WWWpage where I can look this up? 
 
No. You need tyo tell me where she has been and who she has seen, whether 
you want to see someone locally, or obtain a second opinion from one 
outside the area. Top people in this field [behavoioral neurology] are 
Frank Benson at UCLA 310-8259873, Kim Meador in Atlanta, 706-7212797; 
they can also perhaps refer you to top behavioral neurologists in your 
area. 
 
---- The next post from sdickins at cris.com (Stokes Dickins) 
 
This may be a case of transient global amnesia, which can last up to 24   
hours or so.  The person experiencing this cannot form new memories   
during the time it occurs.  Cause is unknown, but it may be related to   
migraine.  Other possibility might be what is called a psychogenic fugue   
state, less likely, but can be seen in individuals with a history of   
prior abuse. I'd suggest you see a Dr. Dewey Zeigler, a neurologist at   
University of Kansas in Kansas City.  I don't know him personally, but he   
has a good reputation as a clinical neurologist.  Hope this helps, Stokes 
 
---- The next post from bill at nsma.arizona.edu (Bill Skaggs) 
 
>  The sort of symptoms you describe could come about in a number of 
>ways: you have given a pretty good description of what happens to a 
>boxer who gets knocked out.  Anything that seriously disrupts the 
>metabolism of a part of the brain called the medial temporal lobe will 
>have similar consequences.  The most obvious possibility, given that 
>the EEG is normal, is an intermittent reduction in blood supply to the 
>medial temporal region of the brain, but generally anything that 
>reduces the oxygen supply to the brain could be responsible, for 
>example hypoglycemia (low blood sugar).  If your wife has not had a 
>really thorough physical examination done, that should be the first 
>thing.  Assuming nothing turns up, you might inquire into the 
>possibility of having a PET scan done the next time the memory loss 
>happens -- I think this would be better than the tests you mentioned 
>for detecting such a problem.  If I were you, I would make some phone 
>calls to Washington University in St. Louis (which has one of the top 
>neuroscience programs in the country) and see if I could find a 
>specialist in memory disorders who would be willing to take a look at 
>your wife. 
> 
>	-- Bill 
> 
>(Please note:  I do research on memory, but I am not a neurologist and 
>have not been to medical school; you should not assume that what I 
>have said is necessarily true or complete.) 
> 
---- The next post  
 
"Ian A. Paul, Ph.D." <iapaul at fiona.umsmed.edu> wrote: 
>It sounds a lot like a series of transient (brief) ischemic attacks. 
>That is, brief periods of diminished cerebral blood flow.  From the 
>description, this restriction may be highly localized to structures 
>involved in short-term memory (e.g. hippocampus).  You mention that 
>the memory loss commonly follows naps.  Although it seems unlikely, it 
>may be possible that a problem similar to orthostatic hypotension is 
>involved (i.e. a transient drop in blood pressure and flow in the brain 
>upon rising from a prone position).  If you neurologist hasn't 
>run a cerebrovascular flow study, I would recommend it.  I would also 
>recommend that you get a second neurological opinion.  If all else 
>fails, you might want to contact either the National Institute of 
>Neurological Diseases and Stroke in Bethesda or the Neurology 
>Department at Washington University in St. Louis.  Both have an 
>excellent reputation in this area. 
> 
>Good Luck, 
> 
>Ian A. Paul, Ph.D. 
 
----- 
Bill Meade, Ph.D.                       Voice=314.516.5623 
Assist. Prof. - Mkt               sbmeade at umslvma.umsl.edu 
U. of Mo. - St. Louis        http://www.umsl.edu/~sbmeade/ 
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