Neurogenic stunned myocardium following hemorrhagic cerebral contusion.
Neurogenic stunned myocardium NSM is a well-known complication of subarachnoidal hemorrhage, but has been reported rarely in association with other central nervous system disorders. A case of NSM is described in a patient with hemorrhagic brain contusion associated with cerebral edema. An 18-year-old man was admitted with severe cranial trauma following a car roll-over. Six days after admission, he developed findings suggestive for NSM. The troponin T and creatine kinase-MB level were elevated and echocardiogram showed apical and inferoposterior hypokinesis and diffuse left ventricular akinesis with severely reduced ejection fraction 18%. Invasive measurements confirmed low cardiac output. His cardiac function resolved completely within 6 days after decompressive craniotomy. This case supports the presumed unifying role of the increased intracranial pressure, probably triggering a vigorous sympathetic outflow hyperactivity leading to NSM.
Deleu
Dirk
D
Department of Neurology, Hamad Medical Corporation, PO Box 3050, Doha, State of Qatar. doc_deleu@hotmail.com
Kettern
Marie-Anne
MA
Hanssens
Yolande
Y
Kumar
Suresh
S
Salim
Khalid
K
Miyares
Francisco
F
D000063:Accidents, Traffic; D000328:Adult; D001929:Brain Edema / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D001930:Brain Injuries / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D003399:Craniotomy / Q000379:methods; D019299:Decompression, Surgical / Q000379:methods; D004569:Electroencephalography; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D009104:Multiple Trauma / Q000175:diagnosis* / Q000601:surgery; D017682:Myocardial Stunning / Q000175:diagnosis / Q000209:etiology*; D018570:Risk Assessment; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome