Seizures and recurrence of Takotsubo syndrome: One clinical presentation and trigger, but two different anatomical variants in the same patient. A case to meditate on

Binaghi, G; Congia, Damiana; Cossa, Stefano; Ganga, R.; Giardina, G.; Matta, Gildo; Merella, W.; Melis, Maurizio; Pasqualucci, Daniele; Serra, Emanuela; Porcu, Maurizio

doi:10.1016/j.seizure.2018.10.014

Cited by 8 publications

(10 citation statements)

References 4 publications

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“…We appreciated the Letter to the Editor by Professor Finsterer concerning our case report previously published in this Journal [1,2].…”

Section: Replymentioning

confidence: 85%

“…

…”

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confidence: 76%

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Recurrent seizure-triggered Takotsubo: A suggestive differential diagnosis

Binaghi

Matta

Melis

et al. 2019

Seizure

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ReplyRecurrent seizure-triggered Takotsubo: A suggestive differential diagnosisWe appreciated the Letter to the Editor by Professor Finsterer concerning our case report previously published in this Journal [1,2].In his letter, Professor Finsterer proposes a mitochondrial disorder as a possible cause for the scenario presented by our patient. However, the patient, a 67-year-old woman, did have any other clinical signs supporting this suggested diagnosis (e.g. short stature, ptosis, double vision, ophthalmoparesis, pigmentary retinopathy, optic atrophy, hypoacusis, hypothyroidism, diabetes, myocardial thickening, non-compaction, vomiting, gastro-intestinal pseudoobstruction, aseptic pancreatitis, renal insufficiency, anaemia, myopathy, neuropathy, or osteoporosis). Furthermore the patient's radiological findings did not support it: there were no basal ganglia calcifications on CT images, and on MRI scan the hippocampal lesions were asymmetrical, although we detected symmetric periventricular white matter hyperintensities (sparing the basal ganglia) there were no stroke-like lesions. Finally, cardiac MRI revealed no gadolinium delayed enhancement, no oedema and normal morphological findings.Moreover, she did not have a family history of epilepsy or conditions potentially related to mitochondrial cytopathy.Having said that, we agree with Professor Finsterer's assertion that the pathogenesis of Takotsubo syndrome is still under debate and hope that careful study and analysis of particular cases such as our can add elements which will ultimately lead to a better understanding of this condition.

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“…We appreciated the Letter to the Editor by Professor Finsterer concerning our case report previously published in this Journal [1,2].…”

Section: Replymentioning

confidence: 85%

“…

…”

mentioning

confidence: 76%

Recurrent seizure-triggered Takotsubo: A suggestive differential diagnosis

Binaghi

Matta

Melis

et al. 2019

Seizure

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“…There have been reports of TS after seizures in the literature. 11 , 12 In fact, a large nationwide population-based study with 981 571 cases of epilepsy-related hospitalizations, showed that the rate of TS in these patients was 1 in 1000 and showed poor inpatient outcomes. 13 In addition, females with a neurological diagnosis appear to be at higher risk of developing TS.…”

Section: Discussionmentioning

confidence: 99%

Case report of Takotsubo syndrome following seizures in a patient with pyruvate carboxylase deficiency

Sahdev

Oji

Babu

et al. 2021

European Heart Journal - Case Reports

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Background Takotsubo syndrome (TS) is defined as transient left ventricular dysfunction, which is often related to an emotional or physically stressful event. We describe a case of TS in a lady with pyruvate carboxylase deficiency (PCD). Pyruvate carboxylase deficiency is rare condition with the majority of those affected demonstrating signs of failure to thrive, recurrent seizures, and metabolic acidosis. To our knowledge, this is the first documented case of TS in an individual with PCD. Case summary This 28-year-old female presented to the emergency department after a tonic-clonic seizure. For 4 days prior to the presentation, she had been suffering from cough and pyrexia. On Day 2, she developed abdominal pain associated with tachycardia and hypotension, and an elevated troponin (791 ng/L). The echocardiogram showed a severely impaired left ventricular systolic function, regional wall motion abnormalities (RWMAs), and a visually estimated left ventricular ejection fraction of 25–30%. Eight days following admission her clinical state significantly improved, with a reduction troponin to 60 ng/L. A repeat echocardiogram on Day 9 showed complete resolution of cardiac function with no RWMAs. Following this, she was discharged from hospital the next day with a diagnosis of TS. Discussion This is the first case report of TS in a patient with PCD. In this case, multiple aetiologies of TS such as emotional and physical stress, seizures, and acute infection were considered. This case also highlights that TS should be an important differential diagnosis in patients presenting with cardiac symptoms.

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“…Thus, according to some data, in 37% of patients with TS, the onset of syndrome was preceded by mental illness [ 96 ]. A TS trigger may be status epilepticus [ 97 , 98 ] or convulsions of a different origin [ 99 - 101 ]. In this regard, it should be noted that bicuculline-induced status epilepticus is accompanied by an increase in the plasma norepinephrine level in dogs [ 102 ].…”

Section: Etiology Of Takotsubo Syndromementioning

confidence: 99%

Takotsubo Syndrome: Clinical Manifestations, Etiology and Pathogenesis

Прокудина

Kurbatov

Zavadovsky

et al. 2021

CCR

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: The purpose of the review is the analysis of clinical and experimental data on the etiology and pathogenesis of takotsubo syndrome (TS). TS is characterized by contractile dysfunction, which usually affects the apical region of the heart, lack of coronary artery obstruction, moderate increase in myocardial necrosis markers, prolonged QTc interval (in 50% of patients), sometimes elevation of ST segment (in 19% of patients), increase N-Terminal Pro-B-Type Natriuretic Peptide level, microvascular dysfunction, sometimes spasm of the epicardial coronary arteries (in 10% of patients), myocardial edema, and life-threatening ventricular arrhythmias (in 11% of patients). Stress cardiomyopathy is a rare disease, it is observed in 0.6 - 2.5% of patients with acute coronary syndrome. The occurrence of takotsubo syndrome is 9 times higher in women, who are aged 60-70 years old , than in men. The hospital mortality among patients with TS corresponds to 3.5% - 12%. In many patients with TS, but not in all, physical or emotional stress precedes the disease. Many patients with TS, but not all, have neurological or mental illnesses. The level of catecholamines is increased in patients with TS, therefore, the occurrence of TS is associated with the excessive activation of the adrenergic system. The negative inotropic effect of catecholamines is associated with the activation of β2 adrenergic receptors. An important role of the adrenergic system in the pathogenesis of TS is confirmed by studies which were performed using 125I-metaiodobenzylguanidine (125I –MIBG). TS causes edema and inflammation of the myocardium. The inflammatory response in TS is systemic. TS causes impaired coronary microcirculation and reduces coronary reserve. There is reason to believe that an increase in blood viscosity may play an important role in the pathogenesis of microcirculatory dysfunction in patients with TS. Epicardial coronary artery spasm is not obligatory for the occurrence of TS. Cortisol, endothelin-1 and microRNAs are challengers for the role of TS triggers. A decrease in estrogen levels is a factor contributing to the onset of TS. The central nervous system appears to play an important role in the pathogenesis of TS.

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Seizures and recurrence of Takotsubo syndrome: One clinical presentation and trigger, but two different anatomical variants in the same patient. A case to meditate on

Cited by 8 publications

References 4 publications

Recurrent seizure-triggered Takotsubo: A suggestive differential diagnosis

Recurrent seizure-triggered Takotsubo: A suggestive differential diagnosis

Case report of Takotsubo syndrome following seizures in a patient with pyruvate carboxylase deficiency

Takotsubo Syndrome: Clinical Manifestations, Etiology and Pathogenesis

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