Amnesia, dissociative disorders and delirium: Pathology review

78 year old Joanne is brought in by her son, who is worried because Joanne seems to forget things all the time.

You start by introducing yourself, and then explain to Joanne the reason she’s in the hospital.

You then ask her a few things about herself.

She looks confused and tells you that she used to be a Broadway singer before retiring and she has travelled all around Europe.

Her son tells you she used to work as a sales woman and she’s never been to Europe in her entire life.

A few minutes later, Joanne asks her son where they are and who you are.

On physical examination, you notice a strong alcoholic odor, so her son reluctantly tells you that Joanne has a history of chronic alcohol abuse.

Next to her, a 66 year old man is also brought to the hospital, after being found by the police wandering in the streets, with a battered suitcase.

He doesn’t seem to know his name, location, or where he was going, and stares blankly when you ask him anything.

The only thing he is able to tell you is that he is going on a business trip.

When you contact his relatives, they tell you that his name is Matthew, and that he was recently fired from his job.

Physical examination is unremarkable.

Based on the initial presentation, both Joanne and Matthew seem to have some form of amnesia, dissociative disorder, or delirium.

Okay, starting with amnesia, this can be categorized into two types.

The first type is anterograde amnesia, which refers to an inability to form new memories, often forgetting what happened hour to hour.

The second and probably most high yield type of amnesia is retrograde amnesia, and it refers to an inability to recall old memories.

As a result, they may completely forget important people or moments in their life, which can cause anxiety for the individual experiencing retrograde amnesia, as well as their friends and family.

Both anterograde and retrograde amnesia can be caused by acute and chronic conditions.

Acute causes include traumatic brain injury or infections that may cause brain inflammation, such as herpes simplex.

On the other hand, chronic causes include brain tumors and neurodegenerative diseases, including Alzheimer disease or other forms of dementia.

For your exams, what’s extremely high yield to remember is that amnesia can also result from vitamin B1 or thiamine deficiency.

Now, thiamine deficiency is typically caused by chronic alcohol abuse, and it can first lead to Wernicke encephalopathy.