Epilepsy and Takotsubo Cardiomyopathy: A Case Report

Abstract

A 60-year-old woman with a history of symptomatic seizures secondary to a subarachnoid hemorrhage was admitted to hospital because of a generalized seizure. The following day, her electrocardiogram showed negative T waves in II, III, aVF, and V2-6, and the echocardiogram showed an impaired left ventricular ejection fraction with ventricular apical akinesia. Head magnetic resonance imaging showed no acute brain injury, but single photon emission computed tomography (SPECT) showed hyperperfusion which affected the left temporal cortex in particular. Hyperactivity of the temporal lobe might cause autonomic nervous system dysfunction and might be related to takotsubo cardiomyopathy.

Takotsubo Cardiomyopathy Following Acute Cerebral Events

“…On the other hand, an increase in catecholaminergic activity has already been described during and after prolonged epileptic seizures or after tonic-clonic seizures alone [15][16][17] . Furthermore, conduction abnormalities and cardiac rhythm troubles are common after epileptic seizures [18] .…”

Takotsubo cardiomyopathy: a rare, but serious, complication of epileptic seizures

“…Focal epileptic activity of the temporal lobe may cause autonomic dysfunction that promotes cardiac damage 4 . The majority of post-epileptic TKC cases are women, mean age 62.7 years.…”

Seizure-related takotsubo cardiomyopathy in a patient with recurrent malignant meningioma

“…The clinical presentation is similar to the acute coronary syndrome, manifesting as chest pain in association with mild cardiac enzyme elevation and electrocardiographic (EKG) changes in the absence of obstructive lesions on coronary angiography [1,2]. Increasingly, cases are being described in the setting of acute neurological illnesses, including malignancy, and seizures [3][4][5][6].…”

“…The clinical presentation is similar to the acute coronary syndrome, manifesting as chest pain in association with mild cardiac enzyme elevation and electrocardiographic (EKG) changes in the absence of obstructive lesions on coronary angiography [1,2]. Increasingly, cases are being described in the setting of acute neurological illnesses, including malignancy, and seizures [3][4][5][6].Compared with typical TTC, seizure-induced TTC confers a higher mortality, thus necessitating prompt recognition and investigation [7].A 76-year-old female with recurrent malignant meningioma presented to the emergency department following a generalized tonic-clonic seizure (GTCS). The patient's history was significant for multiple cranial resections (the most recent one-month prior), two previous seizures, hypercholesterolemia, hypertension and chronic bradycardia.…”

“…The level of circulating catecholamines has been demonstrated to spike in the 30-minutes following a GTCS [8]. This excessive release of catecholamines can cause damage to cardiac muscle, leading to ventricular dysfunction [3,7,9]. In addition, the circulatory complications of seizures, including ventricular arrhythmias, metabolic disturbances and hemodynamic compromise, can provide sufficient physical stress to precipitate TTC in certain patients [7,…”