Division of Cardiology, Emory University School of Medicine, 1365 Clifton Road, NE, 30322, Atlanta, GA, USA.
Neurocrit Care. 2013 Apr;18(2):257-60. doi: 10.1007/s12028-011-9658-9.
Severe subarachnoid hemorrhage may be associated with regional wall motion abnormalities (RWMA) in the absence of epicardial coronary occlusion. The RWMA extends beyond the distribution of a single coronary artery and may present in a typical tako-tsubo cardiomyopathy pattern. Other variants have also been recognized, including an inverted tako-tsubo pattern of severe basal hypokinesis that spares the apex. The mechanism of this cardiomyopathy is not well understood but likely involves catecholamine excess. While classic tako-tsubo cardiomyopathy from emotional stress carries a favorable prognosis, cardiac dysfunction from subarachnoid hemorrhage is a marker of overall poor prognosis.
We collected cases over a period of 4 years at a large teaching hospital. The cases represent cardiac dysfunction in the setting of subarachnoid hemorrhage in the unusual distribution of basal hypokinesis with relative sparing of the apex (inverted tako-tsubo pattern).
A total of four cases were identified. All cases were female between the ages 43-67 years and had echocardiographic evidence of basal hypokinesis after suffering from an intracranial hemorrhage.
The typical and inverted patterns may represent a spectrum within the same disease process or distinct clinical entities with dramatically different prognostic implications. Larger studies comparing the two presentations will help elucidate this further.
严重的蛛网膜下腔出血可能与区域性壁运动异常（RWMA）相关，而无心外膜冠状动脉阻塞。RWMA 超出单个冠状动脉的分布范围，可能呈现典型的 Takotsubo 心肌病模式。其他变体也已被识别，包括严重基底节运动减退的倒置 Takotsubo 模式，心尖部不受累。这种心肌病的发病机制尚不清楚，但可能涉及儿茶酚胺过多。虽然情绪应激引起的经典 Takotsubo 心肌病预后良好，但蛛网膜下腔出血引起的心脏功能障碍是整体预后不良的标志。
我们在一家大型教学医院收集了 4 年来的病例。这些病例代表了蛛网膜下腔出血情况下的心脏功能障碍，其特征为基底节运动减退的不典型分布，心尖部相对不受累（倒置 Takotsubo 模式）。
共发现 4 例。所有病例均为女性，年龄在 43-67 岁之间，在颅内出血后均有超声心动图证据提示基底节运动减退。
典型和倒置模式可能代表同一疾病过程中的一个谱，或具有截然不同的预后意义的不同临床实体。比较两种表现的更大规模研究将有助于进一步阐明这一点。
