What initial investigations should be performed in a patient presenting with symptoms suggestive of TGA?

While the provided UK guidelines do not specifically detail initial investigations for Transient Global Amnesia, a patient presenting with symptoms suggestive of this condition would undergo a comprehensive initial assessment to differentiate from other neurological events such as transient loss of consciousness (TLoC) or transient ischaemic attack (TIA) NICE CG109,NICE NG128.

Initial investigations and assessments typically include:

• Gathering detailed information about the event from the patient and any witnesses, including circumstances, posture before loss of consciousness, prodromal symptoms, appearance during the event, presence or absence of movement (e.g., limb-jerking), any tongue-biting, injury, duration, and presence of confusion or weakness during recovery NICE CG109.
• Obtaining a comprehensive patient history, including details of any previous TLoC, medical history, family history of cardiac disease, and current medications that may have contributed to the event NICE CG109.
• Performing a physical examination, which involves assessing vital signs (pulse rate, respiratory rate, temperature), lying and standing blood pressure if clinically appropriate, and other cardiovascular and neurological signs NICE CG109.
• Recording a 12-lead electrocardiogram (ECG) using automated interpretation, with any abnormalities (e.g., conduction abnormality, long/short QT interval, ST segment or T wave abnormalities) treated as a red flag requiring urgent cardiovascular assessment NICE CG109.
• Excluding hypoglycaemia as a cause of sudden onset neurological symptoms NICE NG128.
• Carrying out relevant examinations and investigations if an underlying problem is suspected, such as checking blood glucose levels for suspected diabetic hypoglycaemia or haemoglobin levels for suspected anaemia or bleeding NICE CG109.
• Using a validated tool, such as FAST (Face Arm Speech Test) or ROSIER (Recognition of Stroke in the Emergency Room), to screen people with sudden onset neurological symptoms for a diagnosis of stroke or TIA NICE NG128.
• Not routinely offering CT brain scanning for suspected TIA unless there is clinical suspicion of an alternative diagnosis that CT could detect NICE NG128.