Analysis In Clinical Features Of Patients With Takotsubo Syndrome Induced By Central Nervous System Disease

BackgroundTakotsubo syndrome(TTS),also known as stress cardiomyopathy or apical ballooning,is constantly induced by psychological or physical stress factors and may yield acute cardiac abnormalities,characterized by transient reversible left ventricular hypokinesis or akinesis.The common clinical presentation of this syndrome is chest pain and dyspnea,mimicking acute myocardial infarction(AMI),at the same time with electrocardiogram(ECG)and serum cardiac markers change.Central nervous system(CNS)disease may cause a number of cardiac abnormalities,including TTS.Thus,timely diagnosis and appropriate management of TTS from CNS disorders is of great importance to relieve the emergent symptoms and improve the quality of life.ObjectiveWe report the rare case of intracranial tumor patient who presented TTS during the perioperative period.Upon implementing effective CPR and postoperative hemodynamic support treatment,the patient recovered well without any complications.On this basis,we systematically reviewed the reported cases of TTS triggered by CNS disease.The purpose of this study was to summarize the clinical features of TTS triggered by CNS disease,and to further analyzed the cause.pathogenesis,diagnosis and treatment,aiming at attachiong more importance to this disease and avoiding misdiagnosis.Methods].We herein report the rare case of a 61-year-old man who suddently presented an episode of ventricular fibrillation during intralcranial tumor resection and was successfully resuscitated.Subsequent echocardiography showed a typical Takotsubo pattern.Within one week,left ventricular systolic function returned to normal.Based on perioperative clinical presentation,auxiliary examination and prognosis,we further analyzed the cause and pathogenesis,and TTS was eventually diagnosed.2.we systematically explored CNKI,Wanfang,Pubmed and Elsevier databases to identify cases of TTS triggered by neurological disorders.The clinical statistics of the patients from selected case reports were gathered,including gender,age,diagnosis of CNS disease,type of TTS and clinical outcome.ResultsWe selected a total of 284 cases with TTS due to CNS disease reported in 120 papers.Among CNS diseases TTS is most frequently associated with subarachnoid hemorrhage(SAH)(n=174),second most frequently with epilepsy(n=174)and third most frequently with ischemic stroke(n=174).234 females and 10 males accounted for 82.3%and 16.5%respectively,and three cases were got rid of owning to gender information.The mean age of all the patients was 57.11±15.67 years.Most patients presented with the typical apical-involving pattern(typical=183;reverse=24;other=12;not reported=65).ECG showed that abnormal ST-segment(elevation or depression)accounted for 42%of all the cases,and T wave inversion for 39%.Different degree of coronary artery stenosis was found in 6%of the patients.The outcome was reported in 279 cases,of which complete recovery was found in 77%and a fatal outcome was in 20%.Five of the fatal outcomes had the inverted type and 28 the typical type.ConclusionsTTS is one of the common complications of CNS diseases,in particular in female patients of post-menopausal phase.The majority presented with the typical,apical-involving pattern.Fortunately,TTS owns favorable prognosis.The excess sympathetic nervous activation results in catecholamine storm which may be the mian pathogenesis inducing the occurrence of TTS.The predilection for neurological damage at or close to the hypothalamic and insular cortex highlights the pivotal role of sympathetic over-activation,which is the most likely cause of cardiac injury.