![]() The patient was discharged with the diagnosis of transient global amnesia. Magnetic resonance imaging of the head with contrast was also normal. Repeat electroencephalography was normal. He still lacked memory for events that occurred the night before and the morning of presentation, but his memory for events after hospital admission returned before discharge. By the next morning, the patient's headache had resolved and he had complete return of anterograde memory. Additional diagnostic studies included electroencephalography, which initially showed mild bitemporal lobe slowing. His ability to form new memories started to improve about 6 hours after his initial presentation in the athletic training room, but he remained unable to recall any events from the night before or the morning of presentation. On admission, reflexes were documented as 2/4 at all sites. The patient was admitted overnight to the neurology service. Blood glucose was 7.5 mmol/L (135 mg/dL) electrolyte, blood urea nitrogen, and creatinine levels and complete blood count were all normal. Toxicology screens were negative for benzodiazepines, barbiturates, cocaine, opiates, cannabinoids, and amphetamines (urine screen) and acetaminophen, salicylate, and ethanol (blood screen). While in the emergency department, he developed a dull headache computed tomography scan of the head was normal. Reflexes in the emergency department were 2+ at the brachial and patellar tendons. He still showed deficits in short-term memory recall otherwise, his neurologic examination remained normal. The patient was referred to the local emergency department for further evaluation of his persistent amnesia. Dipstick urinalysis was negative for ketones. Fingerstick blood glucose level was 5.33 mmol/L (96 mg/dL). Cardiac examination revealed a regular rate and rhythm, and his lungs were clear to auscultation bilaterally. Cerebellar functioning was intact reflexes were 1+ in the Achilles tendon bilaterally and could not be elicited in the biceps or triceps muscle or patella bilaterally. Muscle strength was 5/5 in all major muscle groups of the upper and lower extremities bilaterally. Cranial nerves II through XII were intact. He was able to recall the names and ages of his family members, which high school he attended, and the classes he was enrolled in. He was able to give only 7 words that started with the letter “A” or “F.” There was no agnosia or apraxia. He was unable to recall the words with prompting. ![]() He was able to recall 3/3 words immediately and 0/3 after distraction. He performed serial 7s correctly and missed 1 month when stating the calendar months backward. He was oriented to person, place, and time, except that he reported the date as 1 day earlier. His vital signs were as follows: temperature, 98.2☏ (36.7☌) blood pressure, 143/90 mm Hg heart rate, 82 beats/min respiratory rate, 18 breaths/min. He asked the athletic trainer several times whether he had checked his blood sugar. Upon examination in the athletic training room by the team physician and athletic trainer, the patient was alert but somewhat anxious. Current medications included Novolog at a basal rate of 1.1 to 1.5 units per hour in addition to 1 unit per 12 grams of carbohydrates before each meal. He had no history of migraines, recent illness, or head trauma. The patient denied headache, visual changes, nausea or vomiting, numbness, tingling or weakness in the extremities, or slurred speech. The insulin pump showed no record of any other insulin boluses after midnight. He was unable to recall what he ate, but his roommate confirmed that he had eaten a snack. According to the log on his insulin pump, the patient had given himself a bolus of 5 units of Novolog (Novo Nordisk, Inc, Princeton, NJ) at about midnight and inferred that he must have had a light snack he stated that he never gave himself insulin boluses unless he was about to eat. The roommate and the patient both denied alcohol or drug use, and the roommate reported that the patient was his usual self before going to bed at about 1 am. His roommate reported that they had spent the prior evening watching football and baseball on television. The roommate reported that the patient kept asking questions such as “When is practice?” and “What is my blood sugar?” Upon questioning by the athletic trainer, the patient was unable to recall any events of the previous day and whether he had eaten, checked his blood sugar, or given himself any insulin. A 21-year-old collegiate baseball player with type I diabetes mellitus diagnosed at age 9 years was brought to the athletic training room by his roommate on a Sunday morning at approximately 10 am during the fall practice season because of memory loss.
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