Takotsubo cardiomyopathy: an obscure cause of emerging cardiovascular manifestations in the setting of Bickerstaff’s brainstem encephalitis

Excerpt

Bickerstaff’s brainstem encephalitis (BBE) has been regarded as a specific form of post-infectious and potentially autoimmune neurological disorder with a relatively favorable prognosis and usually presents with sensorial changes, ophthalmoplegia, and ataxia [1, 2]. On the other hand, Takotsubo cardiomyopathy (TTC) has been renowned for its reversible nature and might be largely attributable to significant adrenergic discharge potentially associated with a variety of physical and emotional stressors [2‐5]. In general, TTC generally presents with a variety of clinical signs including electrocardiographic (ECG) changes, specific myocardial wall motion abnormalities on transthoracic echocardiogram (TTE) (left ventricular apical ballooning), and elevation of myocardial enzymes (troponins) along with a wide range of symptoms including chest pain and dyspnea and hence strongly mimicks acute coronary syndromes (ACSs) and other acute heart failure syndromes [4]. Importantly, diagnosis of TTC requires new-onset wall motion abnormalities beyond the territory of a single coronary artery usually in the absence of culprit coronary lesions on coronary imaging [4]. Despite its widely recognized favorable outcome, it may occasionally be complicated by malignant arrhythmias and hemodynamic instability [4]. …