title: Takotsubo Cardiomyopathy Following Acute Cerebral Events.
abstract: OBJECTIVE
  Takotsubo cardiomyopathy (TCM) is characterized by transient apical ventricular dysfunction typically induced by acute stress. Acute cerebral events including ischemic stroke (IS) or epileptic events (EEs) may be associated with massive catecholamine release. We aimed to identify the characteristics and outcomes of patients who experienced the Takotsubo syndrome complicated by IS or EE.
  
  
  METHODS
  Between 2008 and 2013, 87 patients were admitted to our intensive care unit for TCM. Of these, 6 had previously experienced acute cerebral symptoms within 2 days of experiencing either IS or EE. Takotsubo syndrome was diagnosed on cardiac MRI, echocardiography, electrocardiography (ECG), biology and coronary angiography data.
  
  
  RESULTS
  Five women and 1 man were included in the study. The mean age was 63.7 ± 20.1 years (range 44-84). Four of them (67%) initially presented an acute IS and 2 (33%) had EE. The suspected brain injury was found in the insular cortex for 4 patients and the posterior fossa for 2 patients. Hemiparesis, aphasia and cerebellar symptoms were the main neurological signs. Abnormal ECG findings including ST-segment elevation (33%) or T-wave inversion (50%) developed between a few hours and 48 h after the onset of the IS or EE. Peak troponin was 1.8 (0.79-14.11) µg/l. A transient reduction in the left ventricular ejection fraction (46 ± 12%) with apical hypokinesis was found using echocardiography. Two (33%) patients went on to develop acute heart failure. Coronary angiography confirmed the lack of significant coronary stenosis for all 6 patients.
  
  
  CONCLUSIONS
  TCM can develop within the first few days after an acute cerebral event. It occurs predominantly in women with insular or posterior fossa lesions and is possibly induced by vegetative reactions.
authors.affiliation: Department of Neurology, CHU Dijon, Dijon, France.
authors.forename: Christelle
authors.initials: C
authors.lastname: Blanc
authors.forename: Marianne
authors.initials: M
authors.lastname: Zeller
authors.forename: Yves
authors.initials: Y
authors.lastname: Cottin
authors.forename: Benoit
authors.initials: B
authors.lastname: Daubail
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Vialatte
authors.forename: Maurice
authors.initials: M
authors.lastname: Giroud
authors.forename: Yannick
authors.initials: Y
authors.lastname: Béjot
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000150:complications*; D054549:Takotsubo Cardiomyopathy / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology*