Abstract

BackgroundCentral nervous system diseases are common triggers of Takotsubo syndrome. We herein report a rare case of Takotsubo syndrome associated with autoimmune limbic encephalitis.Case presentationA 68-year-old Japanese woman presented to our emergency room with disturbed consciousness. At admission, she showed hypoxemia. Left ventriculography showed akinesia in the middle part of the left ventricle and hyperkinesia in the apical and basal parts of the left ventricle, and the diagnosis of midventricular Takotsubo syndrome was established. However, after an improvement in disturbed consciousness and Takotsubo syndrome symptoms, her brother noticed something wrong with her behavior during his visit to the hospital. Subsequently, we consulted the neurology department 1 week after admission. Her brother revealed a history of abnormal behavior by the patient (such as mistaken entry in the wrong apartment in her building or in another person’s car) a few days prior to the onset of disturbed consciousness, suggesting disorientation of place. Brain magnetic resonance imaging showed an increased signal in the medial aspect of the temporal lobes, which was most clearly observed on the fluid-attenuated inversion recovery sequence; additionally, a cerebrospinal fluid analysis revealed mild lymphocytic pleocytosis. Finally, we established a diagnosis of midventricular Takotsubo syndrome associated with autoimmune limbic encephalitis.ConclusionsIt is presumed that the dysfunction of limbic system due to autonomic limbic encephalopathy is associated with exaggerated sympathetic stimulation. This likely resulted in Takotsubo syndrome in our patient.

Highlights

  • Central nervous system diseases are common triggers of Takotsubo syndrome

  • It is presumed that the dysfunction of limbic system due to autonomic limbic encephalopathy is associated with exaggerated sympathetic stimulation

  • fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) highly restricted to the medial temporal lobes; (3) cerebrospinal fluid (CSF) pleocytosis and/or EEG with epileptic or slow-wave activity involving the temporal lobes; and (4) reasonable exclusion of alternative causes, such as acute disseminated encephalomyelitis, anti-NMDA receptor encephalitis, Bickerstaff ’s brainstem encephalitis, herpes simplex virus encephalitis, paraneoplastic syndrome, and Hashimoto’s encephalopathy [6]

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Summary

Conclusions

It is presumed that the dysfunction of limbic system due to autonomic limbic encephalopathy is associated with exaggerated sympathetic stimulation.

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