title: Apical ballooning resulting from limbic encephalitis.
abstract: 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.
authors.affiliation: Division of Cardiovascular Medicine, Oregon Health and Science University, Portland, OR 97239-3098, USA.
authors.forename: Jill
authors.initials: J
authors.lastname: Gelow
authors.forename: Michael
authors.initials: M
authors.lastname: Kruer
authors.forename: Vijayshree
authors.initials: V
authors.lastname: Yadav
authors.forename: Sanjiv
authors.initials: S
authors.lastname: Kaul
mesh_terms: 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
chemical_list: D005938:Glucocorticoids; D007136:Immunoglobulins; D007155:Immunologic Factors