Morinaga Yusuke, Nii Kouhei, Sakamoto Kimiya, Inoue Ritsurou, Mitsutake Takafumi, Hanada Hayatsura
Department of Neurosurgery, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan.
Intractable Rare Dis Res. 2020 May;9(2):123-125. doi: 10.5582/irdr.2020.01024.
Takotsubo syndrome (TTS) is often preceded by emotional or physical stress. Epileptic seizures have been described in more than 100 TTS cases. Due to the lack of typical symptoms, seizure-induced TTS can be overlooked. Here, we describe a rare case where TTS induced by non-convulsive status epilepticus (NCSE) was diagnosed early and successfully treated. An 82-year-old man presented to our hospital with confusion, anorexia, aphagia, and abnormal behavior beginning a few days earlier. Head computed tomography and magnetic resonance imaging did not show any structural abnormalities. Upon hospitalization, blood sampling revealed elevated levels of myocardial escape enzymes; however, cardiac ultrasonography showed apical asystole, and emergency coronary angiography did not show any significant stenosis or occlusion. The patient's symptoms improved after the administration of antiepileptic drugs consisting of diazepam, fosphenytoin, and levetiracetam. On day 2 of hospitalization, an electroencephalogram showed high amplitude slow waves in the left cerebral hemisphere and NCSE-induced TTS was diagnosed. The patient was discharged after 2 weeks with a modified Rankin Scale score of 0 and continuing oral administration of levetiracetam. Delay in the diagnosis of NCSE-induced TTS can lead to a poor prognosis. Early diagnosis and treatment for NCSE and NCSE-induced TTS may result in favorable outcomes for the patient.
应激性心肌病（TTS）常由情绪或身体应激引发。100多例TTS病例中曾有癫痫发作的描述。由于缺乏典型症状，癫痫发作诱发的TTS可能被忽视。在此，我们描述一例罕见病例，非惊厥性癫痫持续状态（NCSE）诱发的TTS得以早期诊断并成功治疗。一名82岁男性因数天前开始出现意识模糊、厌食、吞咽困难及行为异常前来我院就诊。头颅计算机断层扫描和磁共振成像未显示任何结构异常。住院时，血液检查显示心肌逸出酶水平升高；然而，心脏超声显示心尖部无收缩，急诊冠状动脉造影未显示任何明显狭窄或闭塞。给予地西泮、磷苯妥英和左乙拉西坦组成的抗癫痫药物后，患者症状改善。住院第2天，脑电图显示左脑半球高波幅慢波，诊断为NCSE诱发的TTS。患者2周后出院，改良Rankin量表评分为0分，继续口服左乙拉西坦。NCSE诱发的TTS诊断延迟可导致预后不良。对NCSE及NCSE诱发的TTS进行早期诊断和治疗可能使患者获得良好预后。
