Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
Critical Care, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
BMJ Case Rep. 2022 Jul 22;15(7):e246703. doi: 10.1136/bcr-2021-246703.
A woman in her 30s presented with generalised tonic clonic seizure secondary to known pilocytic astrocytoma. This seizure activity resolved spontaneously after 5 min. On clinical assessment, she was neurologically stable and further neurological investigations did not reveal progression of previously recognised pilocytic astrocytoma. Incidentally, she was found to have an elevated troponin, which significantly increased on serial assessment. ECG was unremarkable and echocardiography revealed regional wall motion abnormalities involving basal segments of the left ventricle with apical sparing. She underwent cardiac MRI, which confirmed the presence of regional wall motion abnormalities seen on echocardiography; however, there was no evidence of myocardial oedema or late gadolinium enhancement. Subsequently, she had an invasive coronary angiogram with intravascular ultrasound which ruled out acute coronary plaque event and coronary dissection. In view of the above, a diagnosis of Takotsubo cardiomyopathy was made. This is a relatively rare entity characterised by the presence of akinesia/hypokinesia in the basal segments with preserved apical contractility; often seen in younger patients.
一位 30 多岁的女性因已知的毛细胞星形细胞瘤出现全身性强直阵挛性发作。这种癫痫活动在 5 分钟后自行缓解。临床评估时，她的神经状态稳定，进一步的神经检查没有发现先前确诊的毛细胞星形细胞瘤进展。偶然发现她的肌钙蛋白升高，连续评估时显著增加。心电图无明显异常，超声心动图显示左心室基底段区域性壁运动异常，心尖段正常。她接受了心脏 MRI，证实了超声心动图上存在区域性壁运动异常；然而，没有心肌水肿或晚期钆增强的证据。随后，她进行了血管内超声的有创冠状动脉造影，排除了急性冠状动脉斑块事件和冠状动脉夹层。鉴于上述情况，诊断为 Takotsubo 心肌病。这是一种相对罕见的疾病，其特征是基底段出现无运动/运动低下，心尖收缩功能正常；常见于年轻患者。
