Takotsubo Cardiomyopathy Following Lateral Medullary Syndrome—A Case Report

Abstract

Neurogenic stress cardiomyopathy (NSC), triggered by acute brain injuries like stroke, manifests as transient cardiac dysfunction, including electrocardiogram (ECG) abnormalities and left ventricular (LV) wall motion changes. Management remains supportive due to high morbidity and mortality. Takotsubo cardiomyopathy, a catecholamine-driven mimic of acute coronary syndrome, is a hallmark of NSC. A 76-year-old hypertensive woman presented with sudden onset giddiness, blurred vision, dysphagia, swaying to the left side, and slurred speech following a posterior circulation stroke. Initial non-contrast computed tomography (NCCT) brain and CT angiogram were unremarkable, but neurological deficits (cranial nerve IX/X palsy, partial left Horner’s syndrome, left cerebellar signs) emerged. Post-thrombolysis, the patient developed hypoxia. Cardiac evaluation revealed elevated troponin, ischemic ECG changes, and echocardiographic findings of apical hypokinesia with basal hyperkinesis, consistent with Takotsubo cardiomyopathy. Normal coronary angiography confirmed NSC. NSC pathophysiology involves excessive catecholamine release, causing myocardial stunning, linked to brain–heart crosstalk. Key medullary regions—rostral ventrolateral medulla (RVLM), nucleus tractus solitarius (NTS)—regulate sympathetic outflow and are often affected in posterior circulation strokes, as in this case. Estrogen deficiency in postmenopausal women may exacerbate susceptibility. Early recognition and intensive care are critical, as delayed diagnosis worsens outcomes.

This case highlights NSC’s association with posterior circulation stroke, a novel observation. Clinicians should maintain high vigilance for NSC in acute brain injury, utilizing prompt cardiac monitoring and imaging to differentiate it from primary cardiac events. Aggressive supportive care, including hemodynamic stabilization, is essential. This report expands understanding of NSC’s clinical spectrum, emphasizing the need for interdisciplinary management to mitigate risks in vulnerable populations.