CHU Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes, F-35000, France.
J Neurol Sci. 2010 Apr 15;291(1-2):100-2. doi: 10.1016/j.jns.2010.01.005. Epub 2010 Feb 1.
A 60-year-old woman presented with a 1-week progressive limb weakness and an areflexic tetraparesis. Both neurophysiological and cerebrospinal fluid examinations were consistent with diagnosis of Guillain-Barré syndrome (GBS) and a treatment by intravenous immunoglobulin over a 5-day period was started. At the end of the treatment, the patient suffered from an acute coronary syndrome (ACS) without stenosis at coronary arteriography. Left ventriculography showed segmental wall motion abnormalities with apical akinesis contrasting with hyperkinesis in basal segments, with a depressed left ventricular ejection fraction at 45%. Cardiac magnetic resonance imaging excluded the diagnosis of myocarditis. A diagnosis of "transient left ventricular apical ballooning syndrome" or "Takotsubo" syndrome was then made and a treatment by angiotensin-converting enzyme inhibitor and beta-blocker was introduced. Left ventricular dysfunction and electrocardiogram normalized within two weeks and the patient remained free from cardiovascular events at one year of follow-up. This cardiomyopathy is a recently known and now commonly diagnosed reversible systolic dysfunction mimicking ACS and is secondary to physical or emotional stress affecting mainly post-menopausal women. Electrocardiographic and echocardiographic abnormalities are often regressive in days or weeks, and rarely responsible for complications. This observation supports clinical evidence that electrocardiographic changes in GBS can be linked to Takotsubo syndrome, by means of the stressful trigger of GBS occurrence. This reversible cardiomyopathy needs adequate management and specific therapeutic strategies. Therefore, trans-thoracic echocardiography should be systematically performed when repolarisation abnormalities are present in this disease to rule out a Takotsubo syndrome, even in asymptomatic patients.
一位 60 岁女性因进行性四肢无力和弛缓性四肢瘫痪就诊，神经生理学和脑脊液检查均符合吉兰-巴雷综合征（GBS）的诊断，并开始静脉用免疫球蛋白治疗 5 天。治疗结束时，患者发生急性冠状动脉综合征（ACS），但冠状动脉造影未见狭窄。左心室造影显示节段性壁运动异常，心尖部无运动与基底段运动过度形成对比，左心室射血分数为 45%。心脏磁共振成像排除了心肌炎的诊断。然后诊断为“短暂性左心室心尖球囊综合征”或“心尖球囊综合征”，并开始使用血管紧张素转换酶抑制剂和β受体阻滞剂进行治疗。左心室功能障碍和心电图在两周内恢复正常，患者在随访 1 年内未发生心血管事件。这种心肌病是一种新近发现的、目前常见的、可诊断的可逆性收缩功能障碍，类似于 ACS，继发于影响主要为绝经后女性的身体或情绪应激。心电图和超声心动图异常通常在数天或数周内消退，很少引起并发症。这一观察结果支持临床证据，即 GBS 中的心电图变化可能与 Takotsubo 综合征有关，原因是 GBS 发生的应激触发。这种可逆性心肌病需要适当的管理和特定的治疗策略。因此，在这种疾病中出现复极异常时，应系统地进行经胸超声心动图检查，以排除 Takotsubo 综合征，即使是无症状患者。
