Cerebellar Ischemia Presenting as Transient Global Amnesia

Transient global amnesia (TGA) consists of acute-onset anterograde amnesia and typically resolves within 24 hours. Reported etiologies of TGA include transient ischemia to the hippocampus or thalamus, migraine, venous flow abnormalities, and epilepsy. There are no reports of cerebellar ischemia as an etiology of TGA. A 78-year-old woman with a medical history of diabetes presented to the Ohio State University ER after a period of anterograde amnesia lasting 3 hours. She was alert during the event, but asked the same questions repeatedly. Upon arrival to the ER, she was hypertensive but clinically back to baseline, with no recall of the 3-hour time period. An MRI of her brain revealed an isolated hyperintense signal on diffusion-weighted imaging (DWI) at the junction of the superior cerebellum and vermis, with apparent diffusion coefficient correlation. Vascular imaging of the brain and neck and a routine EEG were unremarkable. We diagnosed her with cerebellar ischemia presenting as TGA. She had no head injury, migraine, or history of epilepsy to suggest alternative etiologies of TGA. An increasing amount of literature has reported that the cerebellum is linked to the limbic system. A case series of SPECT imaging on individuals with TGA revealed transient cerebellar vermis hypoperfusion in addition to hippocampal DWI changes. We present what may be a novel report of isolated cerebellar ischemia presenting as TGA, and we add to the literature for clinicians to consider the possibility that damage to the cerebellum or its circuit to the cerebrum or thalamus can present as TGA.