Prolonged Cardiac Dysfunction After Intraparenchymal Hemorrhage and Neurogenic Stunned Myocardium

Abstract

Cardiac dysfunction occurring secondary to neurologic disease, termed neurogenic stunned myocardium, is an incompletely understood phenomenon that has been described after several distinct neurologic processes. We present a case of neurogenic stunned myocardium, discovered intraoperatively after anesthetic induction, in a patient who presented to our operating room with a recent intraparenchymal hemorrhage. We discuss the longitudinal cardiac functional course after neurogenic stunned myocardium. Lastly, we discuss the pathophysiology of neurogenic stunned myocardium, as well as its implications for anesthesiologists caring for neurosurgical patients.

Perioperative Stress Cardiomyopathy

“…[1][2][3] Two of these cases are considered by the authors to constitute "neurogenic stunned myocardium," a reasonable classification given their immediate temporal relation to catastrophic neurologic events. The first case involves a 23-yearold woman with subarachnoid hemorrhage who developed severe left ventricular (LV) dysfunction with hypokinesia of the basal LV segments with preservation of the apical segments (often termed an "inverted" or "reverse" takotsubo pattern).…”

“…1 The second case involves a 43-year-old man with intraparenchymal hemorrhage complicated by a history of methamphetamine use without obvious cardiovascular sequelae, who developed severe "global hypokinesia" after induction of anesthesia on hospital day 4 for resection of a cavernoma near the pontomedullary junction. 2 Of note, severe hypertension (210/130 mm Hg), a potential marker of "sympathetic storm," a factor well recognized to precipitate cardiopulmonary dysfunction with severe neurologic injury, 4 was noted on admission.…”