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Inverted (Reverse) Takotsubo Cardiomyopathy following Cerebellar Hemorrhage

DOI: 10.1155/2014/781926

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Background. First described in 2005, inverted takotsubo is one of the four stress-induced cardiomyopathy patterns. It is rarely associated with subarachnoid hemorrhage but was not previously reported after intraparenchymal bleeding. Purpose. We reported a symptomatic case of inverted takotsubo pattern following a cerebellar hemorrhage. Case Report. A 26-year-old woman presented to the emergency department with sudden headache and hemorrhage of the posterior fossa was diagnosed, probably caused by a vascular malformation. Several hours later, she developed acute pulmonary edema due to acute heart failure. Echocardiography showed left ventricular dysfunction with hypokinetic basal segments and hyperkinetic apex corresponding to inverted takotsubo. Outcome was spontaneously favorable within a few days. Conclusion. Inverted takotsubo pattern is a stress-induced cardiomyopathy that could be encountered in patients with subarachnoid hemorrhage and is generally of good prognosis. We described the first case following a cerebellar hematoma. 1. Introduction Stress-induced cardiomyopathy, or takotsubo, is characterized by reversible ventricular dysfunction and mimics acute coronary syndrome with similar symptoms ranging from isolated chest discomfort to, rarely, cardiogenic shock, in the absence of coronary stenosis. The mechanism of takotsubo is still debated, although it seems often triggered by emotional or physical stress. Among these, subarachnoid hemorrhage was previously described as a trigger of importance because heart-related symptoms can precede or be concomitant to cerebral damage and mask neurological symptoms. In the presence of subarachnoid hemorrhage (SAH), takotsubo cardiomyopathy reflects the severity of cerebral hemorrhage and increases the risk of in-hospital death. To our best knowledge, this is the first report of a case of stress cardiomyopathy presenting with an inverted pattern following a cerebellar hemorrhage. 2. Case Description A 26-year-old Caucasian woman without previous medical history was referred to the emergency department for sudden headache. Arterial blood pressure was 110/60?mm Hg and heart rate was 90/min. Because of altered consciousness (Glasgow Coma Scale 6/15), orotracheal intubation was immediately performed. Brain computed tomography (CT) showed an intraparenchymal left cerebellar hemorrhage with massive subarachnoid extension, probably due to a vascular malformation. The first electrocardiogram (ECG) recording in the emergency room showed sinus rhythm with abnormal repolarisation in lateral leads (Figure 1).


[1]  B. G. Song, W. J. Chun, Y. H. Park et al., “The clinical characteristics, laboratory parameters, electrocardiographic, and echocardiographic findings of reverse or inverted Takotsubo cardiomyopathy: comparison with mid or apical variant,” Clinical Cardiology, vol. 34, no. 11, pp. 693–699, 2011.
[2]  R. Ramaraj and M. R. Movahed, “Reverse or inverted Takotsubo cardiomyopathy (reverse left ventricular apical ballooning syndrome) presents at a younger age compared with the mid or apical variant and is always associated with triggering stress,” Congestive Heart Failure, vol. 16, no. 6, pp. 284–286, 2010.
[3]  M.-R. Movahed and K. Mostafizi, “Reverse or inverted left ventricular apical ballooning syndrome (reverse Takotsubo cardiomyopathy) in a young woman in the setting of amphetamine use,” Echocardiography, vol. 25, no. 4, pp. 429–432, 2008.
[4]  B. G. Song, S.-J. Park, H. J. Noh et al., “Clinical characteristics, and laboratory and echocardiographic findings in Takotsubo cardiomyopathy presenting as cardiogenic shock,” Journal of Critical Care, vol. 25, no. 2, pp. 329–335, 2010.
[5]  R. A. Levine, G. J. Vlahakes, X. Lefebvre et al., “Papillary muscle displacement causes systolic anterior motion of the mitral valve: experimental validation and insights into the mechanism of subaortic obstruction,” Circulation, vol. 91, no. 4, pp. 1189–1195, 1995.
[6]  M. Boutonnet, T. Villevieille, C. Pelletier et al., “Sudden death and “inverted Tako-Tsubo”: think of the brain!,” Annales Fran?aises d'Anesthésie et de Réanimation, vol. 31, no. 3, pp. 266–268, 2012 (French).
[7]  A. Ahmadian, A. Mizzi, M. Banasiak et al., “Cardiac manifestations of subarachnoid hemorrhage,” Heart, Lung and Vessels, vol. 5, no. 3, pp. 168–178, 2013.
[8]  P. V. Ennezat, D. Pesenti-Rossi, J. M. Aubert et al., “Transient left ventricular basal dysfunction without coronary stenosis in acute cerebral disorders: a novel heart syndrome (inverted Takotsubo),” Echocardiography, vol. 22, no. 7, pp. 599–602, 2005.
[9]  S. Maréchaux, P. Fornes, S. Petit et al., “Pathology of inverted Takotsubo cardiomyopathy,” Cardiovascular Pathology, vol. 17, no. 4, pp. 241–243, 2008.
[10]  S. Bomann and I. O. Davies, “ED echo of reverse Tako-Tsubo cardiomyopathy: a rare and misleading finding,” The American Journal of Emergency Medicine, vol. 30, no. 9, articl 2088, pp. e3–e5, 2012.
[11]  C. J. Waller, B. Vandenberg, D. Hasan, and A. B. Kumar, “Stress cardiomyopathy with an, “inverse” Takotsubo pattern in a patient with acute aneurysmal subarachnoid hemorrhage,” Echocardiography, vol. 30, no. 8, pp. e224–e226, 2013.
[12]  S. Shoukat, A. Awad, D. K. Nam et al., “Cardiomyopathy with inverted Tako-Tsubo pattern in the setting of subarachnoid hemorrhage: a series of four cases,” Neurocritical Care, vol. 18, no. 2, pp. 257–260, 2013.


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