Advertisement

Neurocritical Care

, Volume 29, Issue 3, pp 508–511 | Cite as

Medulla Oblongata Hemorrhage and Reverse Takotsubo Cardiomyopathy

  • Kevin T. Gobeske
  • Maurice E. Sarano
  • Jennifer E. Fugate
  • Eelco F. Wijdicks
Practical Pearl

Abstract

Background

Acute brain injury with strong surges of adrenergic outflow has resulted in takotsubo cardiomyopathy, but there are surprisingly few reports of takotsubo cardiomyopathy after intracranial hemorrhage, and none have been described from hemorrhage within the brainstem.

Results

We describe a patient with reverse and reversible cardiomyopathy following a hemorrhage in the lateral medulla oblongata. While it is limited in size, the location of the hemorrhage caused acute systolic failure with left ventricular ejection fraction of 27% and vasopressor requirement for cardiogenic shock and pulmonary edema. There was full recovery after 7 days.

Methods

Detailed case report.

Conclusion

Hemorrhage into medulla oblongata pressor centers may result in acute, reversible, stress-induced cardiomyopathy, affirming the adrenergic origin of this condition.

Keywords

Takotsubo cardiomyopathy Intracranial hemorrhage Medulla oblongata Neurogenic cardiac injury 

References

  1. 1.
    Blanc C, Zeller M, Cottin Y, Daubail B, Vialatte AL, Giroud M, Bejot Y. Takotsubo cardiomyopathy following acute cerebral events. Eur Neurol. 2015;74:163–8.CrossRefPubMedGoogle Scholar
  2. 2.
    Finsterer J, Wahbi K. CNS disease triggering Takotsubo stress cardiomyopathy. Int J Cardiol. 2014;177:322–9.CrossRefPubMedGoogle Scholar
  3. 3.
    Finsterer J, Wahbi K. CNS-disease affecting the heart: brain–heart disorders. J Neurol Sci. 2014;345:8–14.CrossRefPubMedGoogle Scholar
  4. 4.
    Nasr DM, Tomasini S, Prasad A, Rabinstein AA. Acute brain diseases as triggers for stress cardiomyopathy: clinical characteristics and outcomes. Neurocrit Care. 2017;27:356–61.Google Scholar
  5. 5.
    Yoshimura S, Toyoda K, Ohara T, Nagasawa H, Ohtani N, Kuwashiro T, Naritomi H, Minematsu K. Takotsubo cardiomyopathy in acute ischemic stroke. Ann Neurol. 2008;64:547–54.CrossRefPubMedGoogle Scholar
  6. 6.
    Nagai M, Dote K, Kato M, Sasaki S, Oda N, Kagawa E, Nakano Y, Yamane A, Higashihara T, Miyauchi S, et al. The insular cortex and Takotsubo cardiomyopathy. Curr Pharm Des. 2017;23:879–88.CrossRefPubMedGoogle Scholar
  7. 7.
    Pelliccia F, Kaski JC, Crea F, Camici PG. Pathophysiology of Takotsubo syndrome. Circulation. 2017;135:2426–41.CrossRefPubMedGoogle Scholar
  8. 8.
    Abd TT, Hayek S, Cheng JW, Samuels OB, Wittstein IS, Lerakis S. Incidence and clinical characteristics of Takotsubo cardiomyopathy post-aneurysmal subarachnoid hemorrhage. Int J Cardiol. 2014;176:1362–4.CrossRefPubMedGoogle Scholar
  9. 9.
    Stollberger C, Wegner C, Finsterer J. Seizure-associated Takotsubo cardiomyopathy. Epilepsia. 2011;52:e160–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Slivnjak V, Lakusic N, Richter D, Cerovec D. Stress cardiomyopathy with ST-segment elevation of the anterolateral location complicated by a secondary massive intracranial bleeding. Int J Cardiol. 2009;136:e63–5.CrossRefPubMedGoogle Scholar
  11. 11.
    Rahimi AR, Katayama M, Mills J. Cerebral hemorrhage: precipitating event for a tako-tsubo-like cardiomyopathy? Clin Cardiol. 2008;31:275–80.CrossRefPubMedGoogle Scholar
  12. 12.
    Bonnemeier H, Krauss T, Brunswig K, Burgdorf C. Severe headache and a broken heart. Europace. 2008;10:1115–6.CrossRefPubMedGoogle Scholar
  13. 13.
    Deininger MH, Radicke D, Buttler J, Scheufler KM, Freiman T, Zentner JF. Takotsubo cardiomyopathy: reversible heart failure with favorable outcome in patients with intracerebral hemorrhage. Case report. J Neurosurg. 2006;105:465–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Shams Y, Lindroos M. Cerebellar haemorrhage triggered Takotsubo-like left ventricular dysfunction syndrome. Int J Cardiol. 2011;151:e85–7.CrossRefGoogle Scholar
  15. 15.
    Tempaku A, Kanda T. Takotsubo-like myocardial dysfunction accompanied with cerebellar hemorrhage. Case Rep Neurol Med. 2012;2012:306171.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Shiromoto T, Shibazaki K, Kimura K, Sakai K. Case of cerebellar hemorrhage complicated with Takotsubo cardiomyopathy—usefulness of plasma brain natriutetic peptide measurement for the diagnosis. Rinsho Shinkeigaku. 2012;52:778–81.CrossRefPubMedGoogle Scholar
  17. 17.
    Ennezat PV, Pesenti-Rossi D, Aubert JM, Rachenne V, Bauchart JJ, Auffray JL, Logeart D, Cohen-Solal A, Asseman P. Transient left ventricular basal dysfunction without coronary stenosis in acute cerebral disorders: a novel heart syndrome (inverted Takotsubo). Echocardiography. 2005;22:599–602.CrossRefPubMedGoogle Scholar
  18. 18.
    Pierard S, Vinetti M, Hantson P. Inverted (Reverse) Takotsubo cardiomyopathy following cerebellar hemorrhage. Case Rep Cardiol. 2014;2014:781926.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Berganzo K, Ciordia R, Gomez-Esteban JC, Tijero B, Agundez M, Velasco F, Valle MA, Zarranz JJ. Takotsubo cardiomyopathy in a patient with bilateral lesions in the dorsal medulla. Clin Auton Res. 2011;21:65–7.CrossRefPubMedGoogle Scholar
  20. 20.
    Venkatraman A, Bajaj NS, Khawaja A, Meador W. Cardiogenic shock from atypical Takotsubo cardiomyopathy attributed to acute disseminated encephalomyelitis lesion involving the medulla. Clin Auton Res. 2016;26:149–51.CrossRefPubMedGoogle Scholar
  21. 21.
    Androdias G, Bernard E, Biotti D, Collongues N, Durand-Dubief F, Pique J, Sanchez I, Delmas C, Ninet J, Marignier R, et al. Multiple sclerosis broke my heart. Ann Neurol. 2017;81:754–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Ruggieri F, Cerri M, Beretta L. Infective rhomboencephalitis and inverted Takotsubo: neurogenic-stunned myocardium or myocarditis? Am J Emerg Med. 2014;32(191):e191–3.Google Scholar
  23. 23.
    Dande AS, Fisher LI, Warshofsky MK. Inverted Takotsubo cardiomyopathy. J Invasive Cardiol. 2011;23:E76–8.PubMedGoogle Scholar
  24. 24.
    Templin C, Ghadri JR, Diekmann J, Napp LC, Bataiosu DR, Jaguszewski M, Cammann VL, Sarcon A, Geyer V, Neumann CA, et al. Clinical features and outcomes of Takotsubo (stress) cardiomyopathy. N Engl J Med. 2015;373:929–38.CrossRefPubMedGoogle Scholar
  25. 25.
    Kato K, Lyon AR, Ghadri JR, Templin C. Takotsubo syndrome: aetiology, presentation and treatment. Heart. 2017;103:1461–9.CrossRefPubMedGoogle Scholar
  26. 26.
    Guyenet PG. The sympathetic control of blood pressure. Nat Rev Neurosci. 2006;7:335–46.CrossRefPubMedGoogle Scholar
  27. 27.
    Ghali MGZ. The brainstem network controlling blood pressure: an important role for pressor sites in the caudal medulla and cervical spinal cord. J Hypertens. 2017;35:1938–47.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Kevin T. Gobeske
    • 1
  • Maurice E. Sarano
    • 2
  • Jennifer E. Fugate
    • 1
  • Eelco F. Wijdicks
    • 1
  1. 1.Division of Critical Care Neurology, Division of Neurocritical Care, Department of NeurologyMayo ClinicRochesterUSA
  2. 2.Division of Cardiology, Department of MedicineMayo ClinicRochesterUSA

Personalised recommendations