Inverted (Reverse) Takotsubo Cardiomyopathy following Cerebellar Hemorrhage.

Sophie Piérard,Marco Vinetti,Philippe Hantson

doi:10.1155/2014/781926

Sophie Piérard, Marco Vinetti + Show 1 more

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https://doi.org/10.1155/2014/781926

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Abstract

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.

Highlights

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
This is the first report of a case of stress cardiomyopathy presenting with an inverted pattern following a cerebellar hemorrhage
Release of troponin is higher compared to other patterns, which is the consequence of the larger muscle region involved in inverse takotsubo compared to apex alone, but, on the other hand, natriuretic peptides is more elevated in apical and midventricular patterns, which is clinically translated by more severe symptoms and higher NYHA functional class [1,2,3]

Summary

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. We reported a symptomatic case of inverted takotsubo pattern following a cerebellar hemorrhage. 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. Inverted takotsubo pattern is a stress-induced cardiomyopathy that could be encountered in patients with subarachnoid hemorrhage and is generally of good prognosis.

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