San Antonio Express-News (Sunday)
Episode of forgetfulness linked to TGA
Q: I recently had a scary episode. According to my family members, for a period of four hours or so, I repeated questions that I should’ve known over and over again. I seemed confused. I did not remember anything; I just said them repeatedly. There was no other neurological changes or stroke symptoms.
I have been under a lot of stress and strain with family issues. After fourand-a-half hours, I became clearheaded again. I did have a slight headache and fogginess for a time after the episode. I am 72 years old.
After seeing my internist, and all the tests came out clear, my final diagnosis was transient global amnesia (TGA). Can you give any information about this condition and what to possibly expect in the future?
A: TGA is a terrifying experience for families. It is most common in people in their 60s and typically lasts about six hours. During this period of time, a person cannot make new memories, so they cannot recall the answers to the questions that they keep asking. (It’s sometimes called the “broken record” effect.)
Headaches are common, but as you say, there are no other neurological symptoms or physical exam findings to suggest a stroke. People with TGA are not at a higher risk for stroke. The emotional stress that you note is a common finding in people who develop this uncommon problem (one person out of 1,000 per year).
Fortunately, the prognosis after TGA is very good. Most cases do not recur.
Q: Have you ever heard of a stapedectomy? I’ve had hearing loss for many years, but I totally lost my hearing about two years ago. It could not be determined why, but a stapedectomy was recommended. I had the surgery, and my
hearing is so much better.
I am tempted to have it done to the other ear so that, possibly, I would not need hearing aids at all. It does not cover nerve damage, but conductive damage is often greatly helped by this. You may want to check this out. I had to ask about it because nobody suggested it to me. Without it, I would have been deaf in one ear.
A:
I have never had a patient undergo stapedectomy. As you correctly say, it is not appropriate for people with hearing loss due to nerve damage, whether through loud noise exposure or the common hearing loss that occurs with age.
It is effective in people with otosclerosis, where the tiny bones in the middle ear fuse and can no longer transmit sound to the inner ear. More than 3 million people in North America have otosclerosis, and it often shows up between ages 20 and 45.
Hearing aids remain a valid
treatment for many people with otosclerosis, but an alternative is the surgical procedure of a stapedectomy, which includes removing a portion of the stapes. (Sound is transmitted from the eardrum to the malleus, to the incus and finally to the stapes.) A piston prosthesis then takes the place of the removed stapes.
More than 90% of people receive hearing improvement from a stapedectomy.
Q: I don’t know what to think; perhaps you can help. As an 83-year-old previously healthy, very active female, I was recently diagnosed first with bronchitis and then with COVID, all in one month. Ten weeks later, I am struggling with dry mouth, gums and lips that no doctor can explain.
Is this one of the long COVID symptoms? I’ve tested negative for the A and B versions of Sjogren’s disease. Can a virus cause an autoimmune disease in a
previously healthy person? And is this just something that I have to learn to live with, as it is quite challenging?
A:
Sjogren’s disease is an autoimmune disease involving many secretory glands, especially those in the mouth and eye. Dry eye and mouth are cardinal symptoms of the disease, but fatigue, muscle aches and sometimes mild cognitive impairment (“brain fog”) are other common symptoms. Although the anti-Ro and anti-La autoantibodies are usually found with Sjogren’s disease, they are not necessary to make the diagnosis and can be found in healthy people without Sjogren’s disease.
There is a clear connection between Sjogren’s and COVID infections, particularly with severe COVID. Several authors have reported cases where the person who developed symptoms was found to have antibodies and proven to have Sjogren’s disease by biopsy during their hospitalization for COVID. A study in lab animals also showed that a COVID infection can induce the Sjogren’s autoantibodies and reduce saliva and eye secretions.
There is not yet long-term data on the prognosis of Sjogren’s disease following COVID. It is possible that the dry mouth will get better over the months, like with other persistent COVID symptoms. However, it is more likely that COVID triggered Sjogren’s disease, and it may be permanent.
Rheumatologists tend to be the experts for Sjogren’s disease, and there are many treatments available beyond symptomatic treatment of dry eyes and mouth.
Q: My wife, 72, had very severe pollen allergies during spring season for the last 37 years. No antihistamine medicine worked for her all these years. Then, this year, after taking all five Moderna COVID-19 vaccines, she didn’t have even a little sign of allergies this year.
Have you heard about this wonderful experience from other people as well?
A:
No, I have not heard that from my patients, nor could I find evidence of that in published reports. It doesn’t seem likely to me that a vaccine would reduce sensitivity to pollen, so I wonder if your wife might’ve been less exposed than in previous years.
If she is very careful and uses a N95 mask, that might explain it, but since masks are not usually necessary when being outdoors, I don’t really have a good reason as to why she has had relief from her allergies.
Some people just have spontaneous relief, although most of my patients tend to get worse over time. Of course, there may be relatively good years and bad years.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth @med.cornell.edu or send mail to 628 Virginia Drive, Orlando, FL 32803.