Neurology Service, Hospital Santa Maria, Centro Hospitalar Lisboa Norte and Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
Cardiology Service, Hospital Santa Maria, Centro Hospitalar Lisboa Norte and Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
Handb Clin Neurol. 2021;177:91-109. doi: 10.1016/B978-0-12-819814-8.00001-9.
There is a multifaceted relationship between the cardiomyopathies and a wide spectrum of neurological disorders. Severe acute neurological events, such as a status epilepticus and aneurysmal subarachnoid hemorrhage, may result in an acute cardiomyopathy the likes of Takotsubo cardiomyopathy. Conversely, the cardiomyopathies may result in a wide array of neurological disorders. Diagnosis of a cardiomyopathy may have already been established at the time of the index neurological event, or the neurological event may have prompted subsequent cardiac investigations, which ultimately lead to the diagnosis of a cardiomyopathy. The cardiomyopathies belong to one of the many phenotypes of complex genetic diseases or syndromes, which may also involve the central or peripheral nervous systems. A number of exogenous agents or risk factors such as diphtheria, alcohol, and several viruses may result in secondary cardiomyopathies accompanied by several neurological manifestations. A variety of neuromuscular disorders, such as myotonic dystrophy or amyloidosis, may demonstrate cardiac involvement during their clinical course. Furthermore, a number of genetic cardiomyopathies phenotypically incorporate during their clinical evolution, a gamut of neurological manifestations, usually neuromuscular in nature. Likewise, neurological complications may be the result of diagnostic procedures or medications for the cardiomyopathies and vice versa. Neurological manifestations of the cardiomyopathies are broad and include, among others, transient ischemic attacks, ischemic strokes, intracranial hemorrhages, syncope, muscle weakness and atrophy, myotonia, cramps, ataxia, seizures, intellectual developmental disorder, cognitive impairment, dementia, oculomotor palsies, deafness, retinal involvement, and headaches.
心肌病与广泛的神经紊乱之间存在着多方面的关系。严重的急性神经系统事件，如癫痫持续状态和颅内动脉瘤性蛛网膜下腔出血，可能导致类似于 Takotsubo 心肌病的急性心肌病。相反，心肌病可能导致广泛的神经系统疾病。在发生指数性神经事件时，可能已经诊断出心肌病，或者神经事件可能促使随后进行心脏检查，最终导致心肌病的诊断。心肌病属于复杂遗传性疾病或综合征的多种表型之一，也可能涉及中枢或外周神经系统。一些外源性药物或危险因素，如白喉、酒精和几种病毒，可能导致继发性心肌病并伴有几种神经系统表现。许多神经肌肉疾病，如肌强直性营养不良或淀粉样变性，在其临床过程中可能表现出心脏受累。此外，一些遗传性心肌病在其临床演变过程中表现出一系列神经表现，通常是神经肌肉性质的。同样，神经并发症可能是心肌病的诊断程序或药物的结果，反之亦然。心肌病的神经表现广泛，包括短暂性脑缺血发作、缺血性中风、颅内出血、晕厥、肌肉无力和萎缩、肌强直、抽搐、共济失调、癫痫发作、智力发育障碍、认知障碍、痴呆、眼肌麻痹、耳聋、视网膜病变和头痛等。
