Division of Neurology, Department of Internal Medicine, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-chuo, Tsuzuki-ku, Yokohama-shi, Kanagawa, 224-8503, Japan.
Division of Cardiology & Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-chuo, Tsuzuki-ku, Yokohama-shi, Kanagawa, 224-8503, Japan.
BMC Cardiovasc Disord. 2021 Feb 11;21(1):86. doi: 10.1186/s12872-020-01789-3.
Central nervous system diseases are common triggers of Takotsubo syndrome. We herein report a rare case of Takotsubo syndrome associated with autoimmune limbic encephalitis.
A 68-year-old Japanese woman presented to our emergency room with disturbed consciousness. At admission, she showed hypoxemia. Left ventriculography showed akinesia in the middle part of the left ventricle and hyperkinesia in the apical and basal parts of the left ventricle, and the diagnosis of midventricular Takotsubo syndrome was established. However, after an improvement in disturbed consciousness and Takotsubo syndrome symptoms, her brother noticed something wrong with her behavior during his visit to the hospital. Subsequently, we consulted the neurology department 1 week after admission. Her brother revealed a history of abnormal behavior by the patient (such as mistaken entry in the wrong apartment in her building or in another person's car) a few days prior to the onset of disturbed consciousness, suggesting disorientation of place. Brain magnetic resonance imaging showed an increased signal in the medial aspect of the temporal lobes, which was most clearly observed on the fluid-attenuated inversion recovery sequence; additionally, a cerebrospinal fluid analysis revealed mild lymphocytic pleocytosis. Finally, we established a diagnosis of midventricular Takotsubo syndrome associated with autoimmune limbic encephalitis.
It is presumed that the dysfunction of limbic system due to autonomic limbic encephalopathy is associated with exaggerated sympathetic stimulation. This likely resulted in Takotsubo syndrome in our patient.
中枢神经系统疾病是 Takotsubo 综合征常见的触发因素。本文报告了一例罕见的 Takotsubo 综合征伴自身免疫性边缘性脑炎病例。
一名 68 岁日本女性因意识障碍就诊于我院急诊科。入院时，患者存在低氧血症。左心室造影显示左心室中部无运动，心尖部和底部运动亢进，诊断为中间段 Takotsubo 综合征。然而，在意识障碍和 Takotsubo 综合征症状改善后，她的哥哥在探视时注意到她的行为有些异常。随后，我们在入院后 1 周请神经内科会诊。其哥哥回忆起患者在发病前几天（如在其居住的大楼错误进入其他住户的房间或他人的汽车内）曾出现过异常行为，提示有地点定向障碍。脑磁共振成像显示内侧颞叶信号增强，在液体衰减反转恢复序列上最为明显；此外，脑脊液分析显示轻度淋巴细胞增多。最终，我们诊断为中间段 Takotsubo 综合征伴自身免疫性边缘性脑炎。
据推测，自主神经边缘性脑炎导致边缘系统功能障碍与交感神经兴奋过度有关。这可能导致了我们的患者发生 Takotsubo 综合征。
