SHM Converge Scientific Abstract ePoster Gallery-Wandering Overnight - A Case of Amnesia and Disinhibition Due to Acute Stroke

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This case describes a 76-year-old woman who presented with altered mental status after wandering downtown and attempting to use her credit card to enter buildings. She had a ground-level fall, about 12 hours of unaccounted time, and no known baseline cognitive problems per collateral history from her husband, friend, and primary care physician. On exam, she was oriented to person, place, and time but did not recognize her memory gap and believed the fall led to hospitalization. She also had mild left arm drift and a minor lip laceration.<br /><br />Brain imaging revealed multifocal acute infarcts in the right middle cerebral artery (MCA) territory, involving the caudate, putamen, corona radiata, external capsule, and subinsular white matter. CTA showed severe right M1 stenosis, supporting presumed artery-to-artery embolism with downstream ischemia. CT head was unremarkable, and cardiac evaluation showed no clear embolic source.<br /><br />Because she was outside thrombolysis and thrombectomy windows, she was treated medically with dual antiplatelet therapy for 21 days, then aspirin alone, along with intensified statin therapy and vascular surgery follow-up. She was discharged after three nights with cognition near baseline.<br /><br />The key teaching point is that acute ischemic stroke can present primarily with neurocognitive symptoms rather than classic focal deficits. In this case, retrograde amnesia was likely caused by disruption of frontal-temporal-limbic memory networks from subcortical and white matter infarcts. The report emphasizes that basal ganglia injury and white matter “disconnection syndromes” can produce memory loss and disinhibition, and that a mild neurologic exam does not exclude significant stroke. Collateral history was essential for diagnosis.

Asset Subtitle

Sahar Taghvaei

Meta Tag

Author List Kaylee Larsen, Madellena Conte, Sahar Taghvaei

Category Clinical Vignettes

Concept Acute Ischemic Stroke

Concept Retrograde Amnesia

Concept Disinhibition

Concept Right Middle Cerebral Artery

Concept Memory Impairment

Distinguished Non-Finalist

Presenter Organization Stanford

Presenting Author Sahar Taghvaei

Track Adult

Keywords

acute ischemic stroke

retrograde amnesia

right middle cerebral artery

multifocal infarcts

basal ganglia

subcortical ischemia

artery-to-artery embolism

altered mental status

dual antiplatelet therapy

memory networks

Acute Ischemic Stroke

Retrograde Amnesia

Disinhibition

Right Middle Cerebral Artery

Memory Impairment