Osaka Mishima Emergency Critical Center, 11-1 Minamiakutagawacho, Takatsuki, Osaka 569-1124, Japan.
Osaka Mishima Emergency Critical Center, 11-1 Minamiakutagawacho, Takatsuki, Osaka 569-1124, Japan.
Am J Emerg Med. 2023 Aug;70:209.e5-209.e7. doi: 10.1016/j.ajem.2023.06.012. Epub 2023 Jun 12.
Various neurological disorders and emotional stress may cause left ventricular dysfunction, known as a neurogenic stunned myocardium. A previously healthy 71-year-old woman collapsed immediately after experiencing left arm numbness and pain. Thereafter, the patient complained of anterior chest pain and became comatose. An electrocardiogram showed ST-segment elevation of I, aVL, and V2-3 and depression of II, III, and aVF. Echocardiography revealed anteroseptal hypokinesis of the left ventricle. Emergency coronary angiography revealed no significant stenosis in the coronary arteries; however, left ventriculography revealed obvious anteroseptal hypokinesis. When the patient regained consciousness the following day, tetraplegia was observed. Spinal computed tomography and magnetic resonance imaging revealed an intramedullary spinal cord hemorrhage from the medulla to the conus. The cardiac function recovered, but the patient remained tetraplegic with poor spontaneous respiration. Although its incidence is extremely rare, hematomyelia should be recognized as a potential cause of neurogenic stunned myocardium.
各种神经紊乱和情绪压力都可能导致左心室功能障碍，即所谓的神经源性顿抑心肌。一位原本健康的 71 岁女性在出现左臂麻木和疼痛后立即晕倒。随后，患者诉前胸部疼痛并昏迷。心电图显示 I、aVL 和 V2-3 的 ST 段抬高和 II、III 和 aVF 的压低。超声心动图显示左心室前间隔运动减弱。急诊冠状动脉造影显示冠状动脉无明显狭窄；然而，左心室造影显示明显的前间隔运动减弱。第二天患者恢复意识时，发现四肢瘫痪。脊髓计算机断层扫描和磁共振成像显示从延髓到圆锥的脊髓内血肿。心功能恢复，但患者仍四肢瘫痪，自主呼吸差。虽然其发生率极低，但应认识到脊髓血肿是神经源性顿抑心肌的潜在原因之一。
