"This looks like a movie": a case report of post-surgical amnesia

Area of Science:

• Neuroscience
• Cardiology
• Psychiatry

Background:

• A 52-year-old male with adaptive personality disorder underwent mitral valve repair and cardiac ablation for atrial fibrillation.
• The patient experienced intraoperative complications, including severe mitral insufficiency and ischemia.

Observation:

• Postoperatively, the patient exhibited acute retrograde autobiographical memory loss, prosopagnosia (face blindness), and loss of public semantic memory.
• Initial CT scans were normal; MRI was precluded by intra-cardiac leads. Hypoxic-ischemic encephalopathy was initially suspected.
• Neuropsychological testing at 20 days post-surgery confirmed severe retrograde autobiographical memory deficits, semantic knowledge impairment, and prosopagnosia, with average performance in visuospatial and executive functions.

Findings:

• At 34 days post-surgery, following a brief nap, the patient experienced a sudden and complete recovery of memory, recalling events up to the day before admission.
• Subsequent neuropsychological assessments revealed normal performance across all previously impaired domains.
• The spontaneous memory recovery and normal MRI findings prompted a diagnostic reevaluation, shifting focus from organic causes to dissociative amnesia.

Implications:

• This case highlights the ongoing debate regarding the organic versus functional etiology of memory disorders, particularly in the context of cardiac surgery complications.
• It underscores the diagnostic challenges in differentiating between organic brain injury and functional neurological disorders, even with advanced neuroimaging.
• The case emphasizes the importance of considering dissociative amnesia in patients presenting with sudden-onset memory loss and cognitive deficits post-procedure, especially when neuroimaging is inconclusive.