Seizure-Associated Takotsubo Syndrome Complicated by Cardiogenic Shock and Successfully Treated with Levosimendan: A Case Report

Abstract

Takotsubo syndrome is an acute and usually reversible cardiac condition with a characteristic left ventricular dysfunction pattern, triggered by emotional or physical events. Multiple causes, including neurologic disorders, have been recognized as triggers. However, an association with status epilepticus has only rarely been reported. We present the case of a 43-year-old woman who developed hemodynamic instability following an episode of status epilepticus and the institution of mechanical ventilation. On intensive care unit admission, the diagnosis of Takotsubo syndrome was made, based on typical findings of regional wall motion abnormality patterns in the transthoracic echocardiography, electrocardiogram alterations, and laboratory findings. The following day the patient was extubated while still dependent on vasopressors. She subsequently developed further hemodynamic compromise, progressing to cardiogenic shock and pulmonary edema. Echocardiography showed persistence of the previous findings. Levosimendan treatment was initiated. Within the subsequent 2 days, the patient was weaned from the vasoactive agents. A repeat echocardiography examination showed marked improvement. She was discharged to ward and subsequently to home, after further echocardiographic improvement. Given the serious complication of cardiogenic shock, and the reversibility of this entity, intensivists should be aware of Takotsubo syndrome in the differential diagnosis in patients with status epilepticus presenting with hemodynamic instability, as well as of the challenges in its treatment.