A case of Takotsubo syndrome during a multiple sclerosis brainstem relapse

The brain-heart connection: a multiple sclerosis relapse presenting as Takotsubo Syndrome. A case report and literature review

“…Neurological conditions, such as stroke, intracranial bleeding [3], head trauma, migraine, and seizures, also represent an important trigger for TTS [4,7]. Few cases of MS related to TTS were previously described as well [16][17][18][19], however the link that this neurological condition has with transient myocardial dysfunction is still debated. To further complicate diagnosis, ECG abnormalities, including ventricular repolarization alterations, without LV dysfunction, were described in patients with various neurological conditions, such as ischaemic stroke, intracranial bleeding and brain tumours [20,21].…”

“…In the few reported cases of MS presenting as TTS [16][17][18][19] the lesions causing the syndrome were all located in the medulla oblongata, where the cardiovascular centre is located. This centre, together with its sympathetic and parasympathetic connection to the cardiovascular system and the adrenal glands, provides modulation and fine tuning of heart rate, the strength of myocardial contractility, i.e.…”

“…Some authors go as far as to suggest that TTS could be an uncommon extra-neurological manifestation of MS [18], as a particular form of neurogenic pulmonary oedema (NPO) [22], called neuro-cardiac NPO [36]. While this link between the conditions and the exact physiopathology of TTS are still debated [1,8,16], one could argue that this definition is not far from the truth. However further research is still needed in order to understand the exact mechanisms of myocardial stunning in TTS, and its possible link with neurological conditions, in particular with demyelinating disease.…”

Stress cardiomyopathy associated with area postrema syndrome as a presentation of neuromyelitis optica: case report

“…However, the absence of angiographic evidence for the coronary angiography and pheochromocytoma, the rapid reversibility of the LV regional wall motion without apical involvement, the elevation in cardiac troponin levels, and the myocardial edema suggested a diagnosis of stress cardiomyopathy, even though a biopsy of the myocardium was not done. Although a catastrophic cardiopulmonary event like stress cardiomyopathy is very rare in CNS demyelinating diseases, several case series associated with MS have been reported [1][2][3][4]. One case series by Androdias et al reported that all patients presented a demyelinating lesion in the medulla oblongata [4].…”

“…Background A rare but relevant association between stress cardiomyopathy (Takotsubo cardiomyopathy) and multiple sclerosis (MS) has been reported in several case series [1][2][3][4]. Neuromyelitis Optica (NMO) is a rarer autoimmune demyelinating disorder of the central nervous system (CNS) by a different immunological mechanism with MS.…”