A mid‐ventricular variant of Takotsubo syndrome: was it triggered by insular cortex damage?

Abstract

Takotsubo syndrome (TTS) is a transient cardiomyopathy that is often associated with cerebrovascular diseases. Earlier studies have supported the concept that the cardiovascular system is regulated by a central autonomic network (CAN) consisting of the insular cortex (IC), anterior cingulate gyrus and amygdala. We report the case of a 79-year-old female diagnosed with a mid-ventricular variant of TTS concomitant with right IC ischaemic stroke. After 12 h of hospitalization, she experienced a sudden collapse. Rapid cardiopulmonary resuscitation resulted in a return of spontaneous circulation. Subsequent left ventriculography revealed akinesis in the mid-portion of the left ventricle with vigorous contraction of the basal and apex segment. Two weeks after admission, cardiac ultrasound showed improved left ventricular contraction. Right IC ischaemia in this patient might have been associated with a dysregulation of the CAN and subsequent increased sympathetic nervous system activity that triggered TTS.

Sex Hormone-Specific Neuroanatomy of Takotsubo Syndrome: Is the Insular Cortex a Moderator?

“…After two weeks of hospitalization, the LV contraction in the mid-portion was improved as shown by cardiac ultrasound. This patient’s right Ic infarction might have been associated with CAN dysregulation that was linked to an increase in sympathetic nervous system activity that triggered TTS [ 96 ].…”

“…In a study of 1750 TTS patients, the apical pattern of TTS was shown to be the most common type (81.7%), and the mid-ventricular pattern was the second most common type (14.6%) [ 97 ]. Although Ic lesion is considered to play a pivotal role as a trigger of TTS [ 4 ], a TTS patient with the mid-ventricular pattern had never been reported in relation to Ic damage until our above-described patient [ 96 ].…”

“…Acute cerebral lesions including the right Ic were observed in the diffusion-weighted ( A ) and FLAIR ( B ) images. From [ 96 ].…”

“…No stenosis was observed in the right coronary artery ( A ), left anterior descending artery, or circumflex artery ( B ). From [ 96 ].…”

“…The extensive area around the mid-portion shows akinesis (arrows), and the basal and apex portions display hypercontraction, especially in the end-systolic phase ( B ). From [ 96 ].…”