Eine Myokarditis mit gravierenden neurologischen Folgen

Abstract

A 39-year-old woman developed severe dyspnea subsequent to a respiratory tract infection. Furthermore an acute loss of vision occurred two days prior to admission. DIAGNOSES AND TREATMENT: Left ventricular dilatation due to myocarditis had led to decompensated cardiac insufficiency. The loss of vision (cortical blindness) had been caused by multiple brain infarctions in the posterior cerebral circulation due to basilary artery occlusion subsequent to cardiogenic embolism. During anticoagulation with heparin and antiplatelet drugs a large, space-occupying intracranial hemorrhage occurred in a posterior cerebral artery infarction. Emergency decompressive craniectomy was necessary. Heart insufficiency and left ventricular dilatation resolved later on. Hydrocephalus became obvious after cranioplasty, thus leading to shunt procedure. After long-term neurorehabilitation, accompanied by several complications and two neurosurgical procedures, the patient gained more independence in her activities of daily living and quality of life. In the light of the initial burden of symptoms this course was rather favorable. Myocarditis as a cause for acute heart insufficiency has to be taken into account in young patients without any history of cardiac abnormalities and preceding infections. Cardioembolic stroke may be a consequence. Decisions in secondary stroke prevention should be made on an individual base with regard to medical guidelines as well as risk factors. Neurorehabilitation of sufficient length and quality can lead to functional recovery, improvement of independence in activities of daily living and quality of life, even if the initial situation seems worse and medical complications accompany the course.