Recurrent takotsubo cardiomyopathy triggered by convulsive status epilepticus.
BACKGROUND
Takotsubo cardiomyopathy can complicate several conditions including neurological emergencies. A few recurrent cases associated with seizures have been reported, but none of the patients had status epilepticus. The pathophysiology of takotsubo syndrome, although debated, may involve stunning of the myocardium by a catecholamine storm triggered by stress. Patients with epilepsy may be at increased risk for takotsubo syndrome, which may occur repeatedly.


METHODS
We report on a postmenopausal woman with symptomatic epilepsy who experienced recurrent takotsubo cardiomyopathy triggered by convulsive status epilepticus. Brief seizures were not associated with takotsubo syndrome. The relevant literature was reviewed.


RESULTS
Over a 1-year period, she experienced two episodes of convulsive status epilepticus with complete neurological recovery after treatment. Echocardiography showed latero-septo-apical hypokinesia and apical ballooning. The cardiac abnormalities resolved fully and she recovered her baseline level of self-sufficiency. During the same period, she experienced several brief seizures, with no cardiac manifestations.


CONCLUSIONS
The occurrence of takotsubo cardiomyopathy in association with convulsive status epilepticus, but not with brief seizures, supports neurogenically mediated myocardial stunning related to direct toxicity of endogenous catecholamines. Neuro-intensivists must be aware of this potentially fatal but fully reversible cardiac complication, which may be among the causes of death in patients with status epilepticus.
Legriel
Stephane
S
Service de Réanimation Polyvalente, Hôpital André Mignot, Centre Hospitalier de Versailles, 177 rue de Versailles, 78157, Le Chesnay Cedex, France. stlegriel@invivo.edu
Bruneel
Fabrice
F
Dalle
Ludovic
L
Appere-de-Vecchi
Corinne
C
Georges
Jean Louis
JL
Abbosh
Nathalie
N
Henry-Lagarrigue
Matthieu
M
Revault D'Allonnes
Laure
L
Ben Mokhtar
Hager
H
Audibert
Juliette
J
Guezennec
Pierre
P
Troche
Gilles
G
Bedos
Jean Pierre
JP
D003422:Critical Care; D004830:Epilepsy, Tonic-Clonic / Q000150:complications*; D005260:Female; D006801:Humans; D008875:Middle Aged; D012008:Recurrence; D013226:Status Epilepticus / Q000150:complications*; D054549:Takotsubo Cardiomyopathy / Q000209:etiology* / Q000628:therapy