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Journal Article Epublish 5 citations

PubMed: 33573602 DOI: 10.1186/s12872-020-01789-3

Takotsubo syndrome associated with autoimmune limbic encephalitis: a case report.

BMC Cardiovasc Disord 21(1):86

Authors: Yuki Kakinuma, Taro Kimura, Yoshiki Sakae, Satomi Kubota, Kenjiro Ono, Ryuta Kinno

Affiliations

  • Division of Neurology, Department of Internal Medicine, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-chuo, Tsuzuki-ku, Yokohama-shi, Kanagawa, 224-8503, Japan.
  • Division of Cardiology & Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-chuo, Tsuzuki-ku, Yokohama-shi, Kanagawa, 224-8503, Japan.
  • Division of Neurology, Department of Medicine, Showa University, School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan.
  • Division of Neurology, Department of Internal Medicine, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-chuo, Tsuzuki-ku, Yokohama-shi, Kanagawa, 224-8503, Japan.

Abstract

BACKGROUND

Central nervous system diseases are common triggers of Takotsubo syndrome. We herein report a rare case of Takotsubo syndrome associated with autoimmune limbic encephalitis.

CASE PRESENTATION

A 68-year-old Japanese woman presented to our emergency room with disturbed consciousness. At admission, she showed hypoxemia. Left ventriculography showed akinesia in the middle part of the left ventricle and hyperkinesia in the apical and basal parts of the left ventricle, and the diagnosis of midventricular Takotsubo syndrome was established. However, after an improvement in disturbed consciousness and Takotsubo syndrome symptoms, her brother noticed something wrong with her behavior during his visit to the hospital. Subsequently, we consulted the neurology department 1 week after admission. Her brother revealed a history of abnormal behavior by the patient (such as mistaken entry in the wrong apartment in her building or in another person's car) a few days prior to the onset of disturbed consciousness, suggesting disorientation of place. Brain magnetic resonance imaging showed an increased signal in the medial aspect of the temporal lobes, which was most clearly observed on the fluid-attenuated inversion recovery sequence; additionally, a cerebrospinal fluid analysis revealed mild lymphocytic pleocytosis. Finally, we established a diagnosis of midventricular Takotsubo syndrome associated with autoimmune limbic encephalitis.

CONCLUSIONS

It is presumed that the dysfunction of limbic system due to autonomic limbic encephalopathy is associated with exaggerated sympathetic stimulation. This likely resulted in Takotsubo syndrome in our patient.

MeSH

Limbic Encephalitis, Cardiovascular Diseases, Consciousness, Diagnosis, Encephalitis, Takotsubo Cardiomyopathy

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