Hammer Niels, Kühne Christian, Meixensberger Jürgen, Hänsel Bernd, Winkler Dirk
Institute of Anatomy, University of Leipzig, Liebigstraße 13, D-04103 Leipzig, Germany.
Department of Neuroradiology, University of Leipzig, Liebigstraße 20, D-04103 Leipzig, Germany.
Int J Surg Case Rep. 2015;6C:172-4. doi: 10.1016/j.ijscr.2014.10.002. Epub 2014 Dec 11.
Takotsubo cardiomyopathy is an apical ballooning syndrome, which can be triggered by stress. Only few case reports describe the onset of Takotsubo as a complication of neurosurgery procedures.
A case of a 53 year-old female with a spinal neurinoma and surgery-associated Takotsubo cardiomyopathy is demonstrated. The patient developed typical signs of a myocardial infarction with circulation depression and ST elevation, but normal cardiac enzymes at the end of surgery. Cardiac catheterization and levocardiography confirmed the absence of any critical coronary disease but the presence of a typical apical ballooning and midventricular hypokinesis. The patient recovered completely under supportive conservative and cardiological therapy, showing regular left ventricular pump function.
Interventions in neurosurgery and perioperative care should be kept as stress free as possible. Due to the possibility of neurogenic mechanisms related to cardiomyopathy, Takotsubo cardiomyopathy as an entity of stress-induced complications should be taken into consideration.
应激性心肌病是一种心尖部气球样综合征，可由应激引发。仅有少数病例报告描述了应激性心肌病作为神经外科手术并发症的发病情况。
展示了一例53岁患有脊髓神经鞘瘤且伴有手术相关应激性心肌病的女性病例。患者在手术结束时出现了心肌梗死的典型症状，伴有循环抑制和ST段抬高，但心肌酶正常。心脏导管检查和左心室造影证实不存在任何严重冠状动脉疾病，但存在典型的心尖部气球样变和心室中部运动减弱。患者在支持性保守治疗和心脏治疗下完全康复，左心室泵功能正常。
神经外科手术及围手术期护理应尽可能减少应激。由于存在与心肌病相关的神经源性机制的可能性，应考虑将应激性心肌病作为应激诱导并发症的一种情况。
