Abstract
BackgroundAcute left ventricular (LV) systolic failure as a consequence of acute severe brain injury with status epilepticus in a young infant is not common; managing such a patient on extracorporeal membrane oxygenation (ECMO), which requires proper anticoagulation adds further substrate to a particularly intriguing and novel case worthy of reporting. Takotsubo syndrome and its peculiar clinical presentation is not commonly reported in the paediatric population, yet the high likelihood of this diagnosis joining the dots up for this case invites our curiosity and reflection through the clinical management of this case.Case presentationA previously healthy 9-month-old local Chinese boy presented with generalised seizures secondary to acute severe brain injury, with signs of sympathetic overdrive, followed by rapidly progressive cardiogenic shock and respiratory failure, eventually requiring ECMO support. Neuroimaging at presentation revealed bilateral subdural haemorrhages. His cardiac function recovered within the next 24 h revealing the reversibility nature of Takotsubo cardiomyopathy.ConclusionsThis is a captivating case depicting a series of unfortunate and unpredictable clinical events occurring in a previously well infant, which at initial presentation challenged the managing team with regards to its exact aetiology of acute brain injury and acute cardiorespiratory failure. Consideration of various differential diagnoses and finally narrowing down to that of stress-induced reversible cardiomyopathy (Takotsubo syndrome) following his intracranial bleed, versus that of coexisting dual pathology – acute brain injury with concomitant acute viral myocarditis, deepened our understanding of the pathophysiology of each disease process, and how it possibly interlinks between different organ systems.
Highlights
Acute left ventricular (LV) systolic failure as a consequence of acute severe brain injury with status epilepticus in a young infant is not common; managing such a patient on extracorporeal membrane oxygenation (ECMO), which requires proper anticoagulation adds further substrate to a intriguing and novel case worthy of reporting
Consideration of various differential diagnoses and narrowing down to that of stress-induced reversible cardiomyopathy (Takotsubo syndrome) following his intracranial bleed, versus that of coexisting dual pathology – acute brain injury with concomitant acute viral myocarditis, deepened our understanding of the pathophysiology of each disease process, and how it possibly interlinks between different organ systems
The initial differential diagnoses considered for his presentation of acute LV failure with acute pulmonary oedema were: severe septic shock with myocardial depression, acute viral myocarditis, underlying undiagnosed congenital structural or coronary anomalies, hereditary cardiomyopathy, and lastly Takotsubo cardiomyopathy
Summary
Acute left ventricular (LV) systolic failure as a consequence of acute severe brain injury with status epilepticus in a young infant is not common; managing such a patient on extracorporeal membrane oxygenation (ECMO), which requires proper anticoagulation adds further substrate to a intriguing and novel case worthy of reporting. Case presentation: A previously healthy 9-month-old local Chinese boy presented with generalised seizures secondary to acute severe brain injury, with signs of sympathetic overdrive, followed by rapidly progressive cardiogenic shock and respiratory failure, eventually requiring ECMO support. Case presentation A previously healthy 9-month-old local Chinese boy presented to emergency department with acute onset of generalised seizures. He was well except for mild upper respiratory tract symptoms with intermittent low-grade fever a week prior. Emergency Medical Services (EMS) was activated and arrived approximately 20 min later His childcare teacher, who had no prior basic life support training, commenced chest compressions and rescue breathing prior while waiting for EMS, as he appeared off-colour during the seizures.
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