Transient global amnesia following abrupt discontinuation of escitalopram

Fernández-Fernández, Francisco José

doi:10.1016/j.medcli.2023.07.015

array:23 ["pii" => "S0025775323004657" "issn" => "00257753" "doi" => "10.1016/j.medcli.2023.07.015" "estado" => "S300" "fechaPublicacion" => "2024-01-12" "aid" => "6391" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2023" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2024;162:42" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:18 [ "pii" => "S0025775323004694" "issn" => "00257753" "doi" => "10.1016/j.medcli.2023.07.019" "estado" => "S300" "fechaPublicacion" => "2024-01-12" "aid" => "6395" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2024;162:43" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "Letter to the Editor" "titulo" => "Characterization of South-East Asian ovalocytosis using osmotic gradient ektacytometry" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "43" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Caracterización de la ovalocitosis del sud-este asiático mediante ectacitometría de gradiente osmótico" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 452 "Ancho" => 1340 "Tamanyo" => 101456 ] ] "descripcion" => array:1 [ "en" => "(a) Blood film image (May-Grünwald-Giemsa stain, 1000× objective) of the patient with South-East Asian ovalocytosis showing anisocytosis with poikilocytosis with ovalocytes and stomatocytes; some of them with more than one stoma (arrow). (b) Osmoscan curve showing a flat curve in SAO patient confirming decreased RBC deformability (green: normal patient; orange: patient with South-East Asian ovalocytosis)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Marta Canelo-Vilaseca, Inés Hernández-Rodríguez, José-Tomás Navarro" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Marta" "apellidos" => "Canelo-Vilaseca" ] 1 => array:2 [ "nombre" => "Inés" "apellidos" => "Hernández-Rodríguez" ] 2 => array:2 [ "nombre" => "José-Tomás" "apellidos" => "Navarro" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775323004694?idApp=UINPBA00004N" "url" => "/00257753/0000016200000001/v1_202401010505/S0025775323004694/v1_202401010505/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0025775323004621" "issn" => "00257753" "doi" => "10.1016/j.medcli.2023.07.012" "estado" => "S300" "fechaPublicacion" => "2024-01-12" "aid" => "6388" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2024;162:41" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "Carta al Editor" "titulo" => "Síndrome de Gitelman y diabetes mellitus tipo 1: una asociación infrecuente" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "41" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Gitelman syndrome and type 1 diabetes mellitus: An uncommon association" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Silvia Patricia Alonso, Marta Domínguez-López" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Silvia Patricia" "apellidos" => "Alonso" ] 1 => array:2 [ "nombre" => "Marta" "apellidos" => "Domínguez-López" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020623005168" "doi" => "10.1016/j.medcle.2023.07.014" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020623005168?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775323004621?idApp=UINPBA00004N" "url" => "/00257753/0000016200000001/v1_202401010505/S0025775323004621/v1_202401010505/es/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Letter to the Editor" "titulo" => "Transient global amnesia following abrupt discontinuation of escitalopram" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "42" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Francisco José Fernández-Fernández" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Francisco José" "apellidos" => "Fernández-Fernández" "email" => array:1 [ 0 => "fjf.fernandez2@gmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Medicina Interna, Complejo Hospitalario Universitario de Ferrol, Ferrol 15405, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Amnesia global transitoria tras interrupción brusca de un tratamiento con escitalopram" ] ] "textoCompleto" => "Transient global amnesia (TGA) is a syndrome characterized by a sudden, complete inability to retain new information, accompanied by repetitive questioning, lasting from minutes to hours, with preservation of alertness and without compromise of other neurologic functions. In this paper I describe the case of a 53-year-old man who experienced a clinical picture compatible with transient global amnesia after abrupt discontinuation of escitalopram.A 53-year-old man with a history of depression presented to the emergency department complaining of that when he returned home from shopping did not remember what he had done in the previous hours. He had repetitive questioning and was amnestic but oriented to time, place and person. The neurologic examination was normal. The emergency blood tests showed an Hb of 16.9g/dl. Blood levels of glucose and electrolytes were normal, as were the results of liver-function and kidney-function tests. A computed tomography of the brain and the electroencephalogram were normal. He was discharged from the hospital. A magnetic resonance imaging of the brain performed on an outpatient basis showed no alterations. One month later, in the outpatient clinic, he was fine and told us that he had not taken his treatment with escitalopram since 3 days before the episode of amnesia. In follow-up 6 months after the episode, he remains asymptomatic.TGA may be preceded by a precipitating event, such as an activity associated with a Valsalva maneuver, emotional stress, exposure to extreme temperatures, sexual intercourse, or severe pain.<a class="elsevierStyleCrossRef" href="#bib0030">1</a> TGA is significantly more likely to occur, among other processes, in patients with a history of depression.<a class="elsevierStyleCrossRef" href="#bib0035">2</a>The cause of TGA is still unknown. The delayed appearance of unilateral o bilateral punctate DWI/T2 lesions in the hippocampus, on magnetic resonance imaging (MRI) performed many hours after the episode, in a proportion of affected patients, provides support for a vascular etiology.<a class="elsevierStyleCrossRef" href="#bib0030">1</a>Selective serotonin reuptake inhibitors have emerged as first-line drugs for treating depressive disorders and patients with a history of depression are significantly more likely to have TGA and TGA recurrence.<a class="elsevierStyleCrossRef" href="#bib0035">2</a> Likewise, mental shock and high-stress events are precipitating factors of TGA.<a class="elsevierStyleCrossRef" href="#bib0030">1</a> Interestingly, in one study in a patient with post-traumatic stress disorder, the exposure to a stressful trigger resulted in decreased regional cerebral blood flow in areas involved in memory, emotion, attention and motor-control. The administration of fluoxetine resulted in normalization of cerebral blood flow in these areas.<a class="elsevierStyleCrossRef" href="#bib0040">3</a>The selective serotonin reuptake inhibitor discontinuation syndrome can occur with any selective serotonin reuptake inhibitor, although antidepressants with short half-lives are associated with a higher risk of discontinuation syndrome, compared to antidepressants with a long half-life. Usually, the symptoms occur within two to four days after drug cessation and the most common symptoms are Flu-like symptoms, dizziness, “shocklike sensations,” gait incoordination, nausea, insomnia and hyperarousal.<a class="elsevierStyleCrossRef" href="#bib0045">4</a>Amnesia as an isolated manifestation of a selective serotonin reuptake inhibitor discontinuation syndrome is rare and, as this case shows, a clinical picture compatible with transient global amnesia can be seen after abrupt discontinuation of escitalopram. The causality algorithm of the Spanish Pharmacovigilance System showed a score of 6, indicating a probable relationship between the patient's transitory global amnesia and his abrupt discontinuation of escitalopram. To my knowledge, similar cases have not been reported and a PubMed search without a year filter with the MeSH terms “Transient Global Amnesia” and “escitalopram” showed no results.Some authors point out that extensive evaluation of patients with transient global amnesia is not necessary unless there are atypical features.<a class="elsevierStyleCrossRef" href="#bib0030">1</a> Therefore, it is important to keep in mind that among the less common symptoms of a selective serotonin reuptake inhibitor discontinuation syndrome is amnesia.<a class="elsevierStyleCrossRef" href="#bib0050">5</a> Taking this possibility into account can avoid unnecessary complementary explorations.Ethical considerationsConsent was obtained from the patient for the publication.FundingNone declared.Conflict of interestThere is no conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Ethical considerations" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Funding" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflict of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transient global amnesia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A.H. Ropper" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMra2213867" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2023" "volumen" => "388" "paginaInicial" => "635" "paginaFinal" => "640" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36791163" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transient global amnesia: current perspectives" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.R. Spiegel" 1 => "J. Smith" 2 => "R.R. Wade" 3 => "N. Cherukuru" 4 => "A. Ursani" 5 => "Y. Dobruskina" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2147/NDT.S130710" "Revista" => array:6 [ "tituloSerie" => "Neuropsychiatr Dis Treat" "fecha" => "2017" "volumen" => "13" "paginaInicial" => "2691" "paginaFinal" => "2703" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29123402" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Brain function in a patient with torture related post-traumatic stress disorder before and after fluoxetine treatment: a positron emission tomography provocation study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Fernández" 1 => "A. Pissiota" 2 => "Ö. Frans" 3 => "L. von Knorring" 4 => "H. Fischer" 5 => "M. Fredrikson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0304-3940(00)01674-8" "Revista" => array:6 [ "tituloSerie" => "Neurosci Lett" "fecha" => "2001" "volumen" => "297" "paginaInicial" => "101" "paginaFinal" => "104" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11121880" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antidepressant discontinuation syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Gabriel" 1 => "V. Sharma" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1503/cmaj.160991" "Revista" => array:5 [ "tituloSerie" => "CMAJ" "fecha" => "2017" "volumen" => "189" "paginaInicial" => "E747" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28554948" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Selective serotonin reuptake inhibitor discontinuation syndrome: a randomized clinical trial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.F. Rosenbaum" 1 => "M. Fava" 2 => "S.L. Hoog" 3 => "R.C. Ascroft" 4 => "W.B. Krebs" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0006-3223(98)00126-7" "Revista" => array:6 [ "tituloSerie" => "Biol Psychiatry" "fecha" => "1998" "volumen" => "44" "paginaInicial" => "77" "paginaFinal" => "87" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9646889" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/00257753/0000016200000001/v1_202401010505/S0025775323004657/v1_202401010505/en/main.assets" "Apartado" => array:4 [ "identificador" => "66430" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Cartas al Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/00257753/0000016200000001/v1_202401010505/S0025775323004657/v1_202401010505/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775323004657?idApp=UINPBA00004N"]

ISSN: 0025-7753

Medicina Clínica, fundada en 1943, es la única publicación semanal de contenido clínico que se edita en España y constituye el máximo exponente de la calidad y pujanza de la medicina española. Son características fundamentales de esta publicación el rigor científico y metodológico de sus artículos, la actualidad de los temas y, sobre todo, su sentido práctico, buscando siempre que la información sea de la mayor utilidad en la práctica clínica. Los contenidos de Medicina Clínica abarcan dos frentes: trabajos de investigación original rigurosamente seleccionados atendiendo a su calidad, originalidad e interés, y trabajos orientados a la formación continuada, encomendados por la revista a autores relevantes (Editoriales, Revisiones, Conferencias clínicas y clínico-patológicas, Diagnóstico y Tratamiento). En estos artículos se ponen al día aspectos de destacado interés clínico o conceptual en la medicina actual. Medicina Clínica es un vehículo de información científica de reconocida calidad, como demuestra su inclusión en los más prestigiosos y selectivos índices bibliográficos del mundo.

Ver más Opción Open Access

Indexada en:

Current Contents/Clinical Medicine, Journal Citation Reports, SCI-Expanded, Index Medicus/Medline, Excerpta Medica/EMBASE, IBECS, IME, MEDES, PASCAL, SCOPUS, ScienceDirect