A Case of Reverse Takotsubo Cardiomyopathy Incited by a Spinal Subdural Hematoma

Abstract

Takotsubo cardiomyopathy is a rare syndrome of transient, reversible left ventricular systolic dysfunction. It mimics myocardial infarction clinically and includes elevated cardiac enzymes, but echocardiography reveals apical ballooning and basal hyperkinesis. Infrequently, midventricular or even reverse Takotsubo patterns have been described, involving ballooning of the basal heart without the characteristic ‘Takotsubo’ appearance. There are cases in the literature that support a connection between reverse Takotsubo cardiomyopathy (r-TTC) and neurological insults as inciting factors. We report a case of r-TTC in an otherwise healthy 23-year-old man presenting with back pain, urinary retention, bradycardia, and hypertension. Troponin levels and brain natriuretic peptide (BNP) were elevated, and echocardiogram revealed an ejection fraction (EF) of less than 20%. In addition, MRI demonstrated a spinal subdural hematoma from T1-S1 with no cord compression. Repeated echocardiogram demonstrated an EF of 20-25% with a reverse Takotsubo pattern of cardiomyopathy. With supportive care, his clinical picture improved with normalization of cardiac enzyme and BNP values. This case represents a r-TTC presenting as heart failure in a young, apparently healthy male likely incited by a spinal subdural hematoma. To our knowledge, it is the first of its kind reported.

Management of a recurrent spinal arachnoid cyst presenting as arachnoiditis in the setting of spontaneous spinal subarachnoid hemorrhage: illustrative case

“…These spontaneous subdural hematomas typically manifest in the thoracic spine, 7 with patients commonly presenting with a multitude of symptoms: motor deficits, sensory disturbances, pain, or myelopathy. 1 Interestingly, there are few case reports in which patients initially present with stress-induced cardiomyopathy, 8,9 and few have concurrent or prior intracranial SAH. [10][11][12] In this case report, we describe a cryptogenic and challenging instance of spontaneous SSAH from T6 to T11 with an initial presentation of worsening myelopathy, back pain, and lower-extremity paresthesias.…”

Acute spontaneous spinal subdural hematoma presenting with Takotsubo cardiomyopathy: a rare case report and literature review

“…We have searched the EMBASE, PubMed, CNKI, and Web of Science databases using the terms ‘spinal subdural hematoma and (heart or Takotsubo)’ and identified only two reported cases of acute heart failure induced by SSDH before March 2022 ( 13 , 14 ). The clinical profiles of these cases, including publication year, patient’ age/sex, hematoma location, cause of bleeding, elevation of cTNI and BNP, treatment, follow-up duration, and outcome were summarized in Table 1 .…”

TakoTsubo Syndrome: First an Acute Coronary Vasculitis and Then Prolonged Myocarditis?

“…It is feasible but unproved that incremental sympathetic discharge and catecholamine release, documented in the early stages of TTS [ 38 ], might tend to provoke ischemia via induction of microvascular constriction and increases in myocardial work. Indeed, hypertension has occasionally been reported in the early stages of TTS [ 39 ]. However, surges in catecholamine release contribute both to redox stress and to glycocalyx “shedding”, with associated fluid and leukocyte extravasation [ 40 ].…”