Hsiao Cheng-Lun, Yeh Kuan-Hung, Chen Pei-Ya, Yang Fu-Yi, Chen I-An, Lin Shinn-Kuang
Stroke Center and Department of Neurology.
Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
Acta Neurol Taiwan. 2022 Dec 30;31(4):179-185.
Takotsubo syndrome (TTS) is characterized angiographically by transient left ventricular systolic dysfunction sparing the basal segments of the left ventricle and absence of obstructive coronary artery disease. Epileptic seizures as triggering events for TTS are uncommon, having only been described in approximately 100 previous cases Case report: A 64-year-old woman with a history of recent stroke-related seizures was admitted for an acute onset of right hemiparesis with dull response. Neurological examination revealed a forced deviation of the eyeballs to the left side and quadriplegia. No large intracranial artery occlusion was disclosed through computed tomography angiography, but an acute infarction at the right corona radiata was identified through magnetic resonance imaging. Electroencephalography showed frequent spike-and-wave complexes over the right cerebral hemisphere indicating subtle status epilepticus. Her consciousness deteriorated to a stuporous state, and her eyeballs were forced deviated to the right side with persistent twitching of the right limbs 10 hours later. The convulsive status epilepticus (CSE) subsided after intravenous infusion of midazolam. However, atrial flutter with inverted T-wave and elevated high-sensitivity troponin I were observed 12 hours after CSE. Arrhythmia was soon alleviated through appropriate treatment. A further coronary angiography did not show significant coronary artery stenosis but indicated that the midsection and the apex of the left ventricle ballooned out during systole as the base contracted normally, indicating a Takotsubo syndrome.
Physicians need to monitor unusual arrhythmias, particularly atrial and ventricular arrhythmias, for the possibility of TTS in patients with epileptic seizure.
应激性心肌病（TTS）在血管造影上的特征是左心室收缩功能短暂性障碍，左心室基底部节段未受累，且无阻塞性冠状动脉疾病。癫痫发作作为TTS的触发事件并不常见，此前仅有约100例相关病例报道。病例报告：一名64岁女性，近期有与中风相关的癫痫发作史，因急性右半身轻瘫伴反应迟钝入院。神经系统检查发现眼球向左强迫性偏斜和四肢瘫痪。计算机断层血管造影未发现大的颅内动脉闭塞，但磁共振成像显示右侧放射冠急性梗死。脑电图显示右大脑半球频繁出现棘波和慢波复合波，提示轻微癫痫持续状态。10小时后，她的意识恶化为昏迷状态，眼球向右强迫性偏斜，右肢持续抽搐。静脉输注咪达唑仑后，惊厥性癫痫持续状态（CSE）得到缓解。然而，CSE后12小时观察到心房扑动伴T波倒置和高敏肌钙蛋白I升高。心律失常通过适当治疗很快得到缓解。进一步的冠状动脉造影未显示明显的冠状动脉狭窄，但显示左心室中部和心尖在收缩期膨出，而基底部正常收缩，提示应激性心肌病。
医生需要监测癫痫发作患者是否出现异常心律失常，尤其是房性和室性心律失常，以排查应激性心肌病的可能性。
