To the Editor,

Here we present a case of complicated upper gastrointestinal (GI) endoscopy with transient global amnesia (TGA) without premedication except oral lidocaine spray. A 75-year-old woman was referred to our hospital for detailed examination of iron deficiency anemia. On January 23, 2009, the patient underwent an upper GI endoscopy (about 10 minutes duration by an endoscopist with 10 years of experience) that demonstrated millimetric pale lesions on the distal esophagus, pangastritis, a 3-mm corporal nodule, a 4-to 5-mm nodule, and a 1-cm polyp in the gastric antrum. Multiple gastric biopsies were taken from the antrum and nodules were removed by forceps. We decided to perform polypectomy in another session.

After the endoscopy, the patient kept repeatedly asking questions like "Where am I?" and "Why I am in the hospital?" Her relatives noticed that she had retrograde amnesia going back several years as well as anterograde amnesia. She thought it was still 1989, and when asked about the current prime minister, she named the minister of 1989. She had no difficulty, however, recognizing her accompanying relatives (her daughters). Neurologic examination was normal except for the apparent amnesia. Cranial computed tomography and serum glucose, blood urea nitrogen, creatinine, and electrolyte levels were within normal limits. Twelve hours after endoscopy, she fully regained her memory but was still confused about the exact time of the endoscopic procedure she had undergone. She had no history of a similar memory disturbance or of epilepsy. Duplex sonography of her carotids was normal except for minimal atherosclerotic changes in the right carotid artery, and her transthoracic echocardiography revealed only mild tricuspid regurgitation. With these findings, a diagnosis of TGA precipitated by upper GI endoscopy was made (Hodges & Warlow, 1990).

TGA is usually related to physical and emotional stress such as contact with cold water, hot bath, sexual intercourse, or angiography (Hodges & Warlow, 1990; Quinette et al., 2006). Although the pathogenesis of TGA in our case is unclear, changes in autonomic nervous activity during the procedure have been reported to occur because of anxiety or rapid gastric dilatation (Hayashi et al., 2000). To the best of our knowledge, this is the second reported case of TGA after upper GI endoscopy without premedication in the English literature (Hiraga & Matsunaga, 2006). Although reports of endoscopy-related TGA are very rare (Hiraga & Matsunaga, 2006), GI healthcare providers should be aware that amnesia may occur even in non-premedicated patients after upper GI endoscopy.

Sincerely,

Abdurrahim Sayilir, MD

Mevlut Kurt, MD

Mehmet Ibis, MD

Murat Kekilli, MD

Ibrahim Koral Onal, MD

Nurgul Sasmaz, MD

Abdurrahim Sayilir, Mevlut Kurt, Mehmet Ibis, Murat Kekilli, Ibrahim Koral Onal, and Nurgul Sasmaz are from the Department of Gastroenterology, Turkiye Yuksek Ihtisas Teaching and Research Hospital, Ankara, Turkey.

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