Practical Pearl

Neurocritical Care

, Volume 9, Issue 1, pp 118-121

First online:

Recurrent Takotsubo Cardiomyopathy Triggered by Convulsive Status Epilepticus

  • Stephane LegrielAffiliated withService de Réanimation Polyvalente, Hôpital André Mignot, Centre Hospitalier de Versailles Email author 
  • , Fabrice BruneelAffiliated withService de Réanimation Polyvalente, Hôpital André Mignot, Centre Hospitalier de Versailles
  • , Ludovic DalleAffiliated withService des Urgences, Hôpital André Mignot
  • , Corinne Appere-de-VecchiAffiliated withService de Réanimation Polyvalente, Centre Hospitalier de Poissy
  • , Jean Louis GeorgesAffiliated withService de cardiologie, Hôpital André Mignot
  • , Nathalie AbboshAffiliated withService de Réanimation Polyvalente, Hôpital André Mignot, Centre Hospitalier de Versailles
  • , Matthieu Henry-LagarrigueAffiliated withService de Réanimation Polyvalente, Hôpital André Mignot, Centre Hospitalier de Versailles
  • , Laure Revault D’AllonnesAffiliated withService de Réanimation Polyvalente, Hôpital André Mignot, Centre Hospitalier de Versailles
  • , Hager Ben MokhtarAffiliated withService de Réanimation Polyvalente, Hôpital André Mignot, Centre Hospitalier de Versailles
    • , Juliette AudibertAffiliated withService de Réanimation Polyvalente, Hôpital André Mignot, Centre Hospitalier de Versailles
    • , Pierre GuezennecAffiliated withService de Réanimation Polyvalente, Hôpital André Mignot, Centre Hospitalier de Versailles
    • , Gilles TrocheAffiliated withService de Réanimation Polyvalente, Hôpital André Mignot, Centre Hospitalier de Versailles
    • , Jean Pierre BedosAffiliated withService de Réanimation Polyvalente, Hôpital André Mignot, Centre Hospitalier de Versailles

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Abstract

Introduction

Takotsubo cardiomyopathy can complicate several conditions including neurological emergencies. A few recurrent cases associated with seizures have been reported, but none of the patients had status epilepticus. The pathophysiology of takotsubo syndrome, although debated, may involve stunning of the myocardium by a catecholamine storm triggered by stress. Patients with epilepsy may be at increased risk for takotsubo syndrome, which may occur repeatedly.

Methods

We report on a postmenopausal woman with symptomatic epilepsy who experienced recurrent takotsubo cardiomyopathy triggered by convulsive status epilepticus. Brief seizures were not associated with takotsubo syndrome. The relevant literature was reviewed.

Results

Over a 1-year period, she experienced two episodes of convulsive status epilepticus with complete neurological recovery after treatment. Echocardiography showed latero-septo-apical hypokinesia and apical ballooning. The cardiac abnormalities resolved fully and she recovered her baseline level of self-sufficiency. During the same period, she experienced several brief seizures, with no cardiac manifestations.

Conclusion

The occurrence of takotsubo cardiomyopathy in association with convulsive status epilepticus, but not with brief seizures, supports neurogenically mediated myocardial stunning related to direct toxicity of endogenous catecholamines. Neuro-intensivists must be aware of this potentially fatal but fully reversible cardiac complication, which may be among the causes of death in patients with status epilepticus.

Keywords

Status epilepticus Takotsubo cardiomyopathy Intensive care unit Catecholamines Seizures