Cardiac manifestations of prolonged seizure: A case report on reverse takotsubo syndrome and neurogenic stunned myocardium

Abstract

Seizures, characterized by excessive electrical discharges in the brain, can lead to severe complications, including cardiac arrhythmias and Takotsubo syndrome, a form of stress-induced cardiomyopathy mimicking acute coronary syndrome. We present a case of a 66-year-old female with epilepsy and postcerebrovascular accident status who experienced a 45-minute seizure resulting in elevated troponin levels and ECG changes. Echocardiography revealed severe hypokinesia and hyperkinesia with a left ventricular ejection fraction of 30%-35%, and coronary angiography was normal, leading to the diagnosis of a variant of Takotsubo syndrome characterized by basal rather than apical dysfunction. The patient showed significant improvement after 96 hours in the coronary care unit following adjusted anti-seizure medications and supportive cardiac care. This case highlights the importance of recognizing and managing cardiac complications such as Takotsubo syndrome in patients with neurological events, emphasizing the need for close collaboration between neurology and cardiology to improve patient outcomes.

Keywords

• Neurogenic stunned myocardium
• Takotsubo cardiomyopathy
• Seizure
• Catecholamine storm
• Reversible left ventricular dysfunction