Khoo Teck Puat - National University Children's Medical Institute, National University Health System, Singapore, 1E Kent Ridge Road, Singapore, 119228, Singapore.
BMC Pediatr. 2019 Aug 13;19(1):278. doi: 10.1186/s12887-019-1658-5.
Acute left ventricular (LV) systolic failure as a consequence of acute severe brain injury with status epilepticus in a young infant is not common; managing such a patient on extracorporeal membrane oxygenation (ECMO), which requires proper anticoagulation adds further substrate to a particularly intriguing and novel case worthy of reporting. Takotsubo syndrome and its peculiar clinical presentation is not commonly reported in the paediatric population, yet the high likelihood of this diagnosis joining the dots up for this case invites our curiosity and reflection through the clinical management of this case.
A previously healthy 9-month-old local Chinese boy presented with generalised seizures secondary to acute severe brain injury, with signs of sympathetic overdrive, followed by rapidly progressive cardiogenic shock and respiratory failure, eventually requiring ECMO support. Neuroimaging at presentation revealed bilateral subdural haemorrhages. His cardiac function recovered within the next 24 h revealing the reversibility nature of Takotsubo cardiomyopathy.
This is a captivating case depicting a series of unfortunate and unpredictable clinical events occurring in a previously well infant, which at initial presentation challenged the managing team with regards to its exact aetiology of acute brain injury and acute cardiorespiratory failure. Consideration of various differential diagnoses and finally narrowing down to that of stress-induced reversible cardiomyopathy (Takotsubo syndrome) following his intracranial bleed, versus that of coexisting dual pathology - acute brain injury with concomitant acute viral myocarditis, deepened our understanding of the pathophysiology of each disease process, and how it possibly interlinks between different organ systems.
急性左心室（LV）收缩功能衰竭是由于伴有癫痫持续状态的急性严重脑损伤引起的，在婴幼儿中并不常见；此类患者需要体外膜肺氧合（ECMO）治疗，这需要适当的抗凝，这为一个特别有趣和新颖的病例提供了进一步的依据，值得报告。Takotsubo 综合征及其特殊的临床表现在儿科人群中并不常见，但该诊断与该病例的相关性很高，这引起了我们的好奇心和思考，通过对该病例的临床管理来进行反思。
一名 9 个月大的本地华裔健康男婴因急性严重脑损伤继发全身性癫痫发作，表现出交感神经兴奋过度的迹象，随后迅速发展为心源性休克和呼吸衰竭，最终需要 ECMO 支持。发病时的神经影像学显示双侧硬脑膜下血肿。他的心脏功能在接下来的 24 小时内恢复，揭示了 Takotsubo 心肌病的可逆性。
这是一个引人入胜的病例，描述了一系列不幸和不可预测的临床事件发生在一个原本健康的婴儿身上，在最初的表现中，这对管理团队提出了挑战，需要确定急性脑损伤和急性心肺衰竭的确切病因。考虑了各种鉴别诊断，最终确定为颅内出血后应激诱导的可逆性心肌病（Takotsubo 综合征），而不是同时存在的双重病理 - 急性脑损伤伴急性病毒性心肌炎，加深了我们对每种疾病过程的病理生理学的理解，以及它如何在不同的器官系统之间相互关联。
