Case Report: Takotsubo Cardiomyopathy in Bickerstaff Brainstem Encephalitis Triggered by COVID-19

Takotsubo cardiomyopathy (TCM) is a stress-induced cardiomyopathy triggered by critical illness including severe neurological disorders. However, an association between TCM and Bickerstaff brainstem encephalitis (BBE) has rarely been described. During the current coronavirus disease 2019 (COVID-19) pandemic, growing evidence indicates that COVID-19 often leads to various neurological disorders, but there are few reports of an association between COVID-19 and BBE. Here we report a case of TCM associated with BBE triggered by COVID-19, which subsided with immunotherapy for BBE. Both transthoracic echocardiography and electrocardiography led to early and accurate diagnosis of TCM. Sustained hemodynamic instability due to TCM was immediately lessened with immunotherapy whereas additional plasmapheresis and immunotherapy were required to treat BBE. This case indicates that BBE might follow COVID-19 and TCM should be considered when hemodynamic status remains unstable in a patient with BBE.

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Bickerstaff brainstem encephalitis — /INS;A case report

Journal of the Neurological Sciences ◽

10.1016/j.jns.2013.07.2322 ◽

2013 ◽

Vol 333 ◽

pp. e671

Author(s):

R. Debreczeni ◽

P. Orosz ◽

J. Bihari ◽

D. Bereczki

Keyword(s):

Case Report ◽

Brainstem Encephalitis ◽

Bickerstaff Brainstem Encephalitis

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Reverse takotsubo cardiomyopathy caused by patent foramen ovale-related cryptogenic stroke: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa407 ◽

2020 ◽

Author(s):

Hiroya Takafuji ◽

Junya Arai ◽

Kuniyasu Saigusa ◽

Kotaro Obunai

Keyword(s):

Heart Failure ◽

Case Report ◽

Acute Heart Failure ◽

Takotsubo Cardiomyopathy ◽

Transthoracic Echocardiography ◽

Patent Foramen Ovale ◽

Cryptogenic Stroke ◽

Left Ventricular ◽

Heart Team ◽

Foramen Ovale

Abstract Background Reverse takotsubo cardiomyopathy (rTTC) is recognized as an atypical type of TTC. It has been suggested that neurological events are typical trigger of rTTC, especially in young individuals. Case summary In this case report, we describe a 16-year-girl who presented with neurological deficits due to embolic stroke and acute heart failure. Transthoracic echocardiography on admission revealed a severely reduced left ventricular (LV) function with akinesis of basal to mid LV, but normal contraction in apex. Coronary computed tomography angiography confirmed unobstructed coronary arteries. Two weeks later, her LV wall motion and ejection fraction were completely normalized. Transthoracic echocardiography and transoesophageal echocardiography demonstrated no evidence of intracardiac thrombus but showed a patent foramen ovale (PFO) with large shunt. After thorough work-up and brain–heart team discussion, we concluded that the patient developed rTTC due to cryptogenic stroke related with her PFO. She underwent percutaneous PFO closure for secondary prevention with good clinical course. Discussion Reverse TTC is a rare condition. It should be considered in stroke patients with acute heart failure. Quick diagnosis and management with brain–heart team is crucial for better prognosis.

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