Anesthesia and Neuro-Intensive Care, Head and Neck Department, San Raffaele Scientific Institute, Milan, Italy.
Anesthesia and Neuro-Intensive Care, Head and Neck Department, San Raffaele Scientific Institute, Milan, Italy.
Am J Emerg Med. 2014 Feb;32(2):191.e1-3. doi: 10.1016/j.ajem.2013.08.047. Epub 2013 Sep 27.
Here we originally describe the clinical scenario of a young immune-competent patient affected by acute rhomboencephalitis with severe parenchymal edema and acute hydrocephalus who developed sudden life-threatening cardiac derangement. Hemodynamic and perfusion parameters revealed cardiogenic shock, so intensive circulatory support with epinephrine infusion and intra-aortic balloon pump was needed to restore organ perfusion. Transesophageal echocardiographic examination showed severe left ventricular dysfunction (ejection fraction as low as 20%) with wall motion abnormalities resembling a pattern of Takotsubo-inverted cardiomyopathy. Cultural investigations revealed infection by Listeria monocytogenes. Nevertheless, her conditions rapidly improved, and she had full cardiac recovery within few days. Acute cerebral damage, pattern of echocardiographic wall motion abnormalities, and clinical course may suggest neurogenic stunned as pathological mechanism responsible for cardiac dysfunction, but differential diagnosis with acute myocarditis is to be considered too. Acute cardiogenic shock during the course of rhomboencephalitis by L monocytogenes has not been yet reported; prompt clinical suspicion and intensive care are needed to manage this life-threatening condition.
在这里，我们最初描述了一位年轻免疫功能正常的患者发生急性脑回炎的临床情况，该患者伴有严重的实质水肿和急性脑积水，出现危及生命的心脏功能障碍。血流动力学和灌注参数显示心源性休克，因此需要使用肾上腺素输注和主动脉内球囊泵进行强化循环支持，以恢复器官灌注。经食管超声心动图检查显示严重的左心室功能障碍（射血分数低至 20%），伴有类似于 Takotsubo 倒置性心肌病的室壁运动异常。文化研究显示感染李斯特菌单核细胞增生症。然而，她的病情迅速改善，在几天内完全恢复了心脏功能。急性脑损伤、超声心动图室壁运动异常模式和临床过程可能提示神经源性心搏骤停是导致心脏功能障碍的病理机制，但也需要考虑与急性心肌炎的鉴别诊断。单核细胞增生性李斯特菌引起的脑回炎过程中发生急性心源性休克尚未见报道；需要及时的临床怀疑和强化护理来处理这种危及生命的情况。
