Apical ballooning resulting from limbic encephalitis.
BACKGROUND
Neurogenic stunned myocardium is an increasingly recognized cause of left ventricular apical ballooning, or takotsubo cardiomyopathy. We report the first case of neurogenic stunned myocardium as a result of limbic encephalitis.


METHODS
This 73-year-old woman with anterograde and retrograde amnesia was investigated using electrocardiography, magnetic resonance imaging, and left ventricular angiography.


RESULTS
Electrocardiography showed deep T-wave inversions in multiple leads, magnetic resonance imaging demonstrated increased signal on fluid-attenuated inversion recovery images symmetrically within the medial temporal lobes consistent with limbic encephalitis. Left ventricular angiography showed apical ballooning.


CONCLUSIONS
Because the insula has extensive interconnections with limbic structures, limbic encephalitis could lead to alterations in the sympathetic regulation of the insular cortex resulting in neurogenic stunned myocardium.
Gelow
Jill
J
Division of Cardiovascular Medicine, Oregon Health and Science University, Portland, OR 97239-3098, USA.
Kruer
Michael
M
Yadav
Vijayshree
V
Kaul
Sanjiv
S
D000368:Aged; D020324:Amnesia, Anterograde / Q000209:etiology; D000648:Amnesia, Retrograde / Q000209:etiology; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007136:Immunoglobulins / Q000627:therapeutic use; D007155:Immunologic Factors / Q000627:therapeutic use; D020363:Limbic Encephalitis / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D017682:Myocardial Stunning / Q000209:etiology; D010951:Plasma Exchange / Q000379:methods; D054549:Takotsubo Cardiomyopathy / Q000150:complications / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D016896:Treatment Outcome
D005938:Glucocorticoids; D007136:Immunoglobulins; D007155:Immunologic Factors