The most commonly cited precipitating events include vigorous exercise (including sexual intercourse), swimming in cold water or enduring other temperature changes, and emotionally traumatic or stressful events. TGA attacks are associated with some form of precipitating event in at least one-third of cases. The differences are sufficiently meaningful that transient amnesia may be considered a heterogeneous clinical syndrome with multiple etiologies, corresponding mechanisms, and differing prognoses. The leading hypotheses are some form of epileptic event, a problem with blood circulation around, to or from the brain, or some kind of migraine-like phenomenon. The underlying cause of TGA remains enigmatic. The main sign of this condition is the repetitive actions of something that is not usually repeated. Persons suffering from the attack may vocalize signs that 'they just lost their memory', or that they believed they had a stroke, although they aren't aware of the other signs that they are displaying. There is also evidence that the victim is aware that something is not quite right, even though they can't pinpoint it. There is emerging evidence for observable impairments in a minority of cases weeks or even years following a TGA attack. In the majority of cases there are no long-term effects other than a complete lack of recall for this period of the attack and an hour or two before its onset. While seemingly back to normal within 24 hours, there are subtle effects on memory that can persist longer. The attack lessens over a period of hours, with older memories returning first, and the repetitive fugue slowly lengthening so that the victim retains short-term memory for longer periods. In a large survey, 11% of individuals in a TGA state were described as exhibiting "emotionalism" and 14% "fear of dying". Although confusion is sometimes reported, others consider this an imprecise observation, but an elevated emotional state (compared to patients experiencing Transient Ischemic Attack, or TIA) is common. The individual experiencing TGA retains social skills and older significant memories, almost always including knowing his or her own identity and the identity of family members, and the ability to perform various complex learned tasks including driving and other learned behavior one individual "was able to continue putting together the alternator of his car." Though outwardly appearing to be normal, a person with TGA is disoriented in time and space, perhaps knowing neither the year nor where they reside. One of its bizarre features is perseveration, in which the victim of an attack faithfully and methodically repeats statements or questions, complete with profoundly identical intonation and gestures "as if a fragment of a sound track is being repeatedly rerun." This is found in almost all TGA attacks and is sometimes considered a defining characteristic of the condition. A person experiencing TGA typically has memory only of the past few minutes or less, and cannot retain new information beyond that period of time. This onset of TGA is generally fairly rapid, and its duration varies but generally lasts between 2 and 8 hours. There were no features of epilepsy, or active epilepsy in the past two years, and the patient did not have any recent head injury.
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