Apical Ballooning Resulting from Limbic Encephalitis - 12/08/11

Doi : 10.1016/j.amjmed.2008.12.016

Jill Gelow, MD, MPH ^a, Michael Kruer, MD ^b, Vijayshree Yadav, MD ^c,^d, Sanjiv Kaul, MD ^a,^⁎
^a Division of Cardiovascular Medicine, Oregon Health and Science University, Portland
^b Department of Medicine, Divisions of Pediatric Neurology and Developmental Pediatrics, Oregon Health and Science University, Portland
^c Department of Pediatrics, Oregon Health and Science University, Portland
^d Division of Neuroimmunology, Department of Neurology, Oregon Health and Science University, Portland

Requests for reprints should be addressed to Sanjiv Kaul, MD, Division of Cardiovascular Medicine, Oregon Health and Science University, UHN62, 3181 SW Sam Jackson Park Road, Portland, Oregon 97239-3098

Abstract

Background

Neurogenic stunned myocardium is an increasingly recognized cause of left ventricular apical ballooning, or takotsubo cardiomyopathy. We report the first case of neurogenic stunned myocardium as a result of limbic encephalitis.

Methods

This 73-year-old woman with anterograde and retrograde amnesia was investigated using electrocardiography, magnetic resonance imaging, and left ventricular angiography.

Results

Electrocardiography showed deep T-wave inversions in multiple leads, magnetic resonance imaging demonstrated increased signal on fluid-attenuated inversion recovery images symmetrically within the medial temporal lobes consistent with limbic encephalitis. Left ventricular angiography showed apical ballooning.

Conclusions

Because the insula has extensive interconnections with limbic structures, limbic encephalitis could lead to alterations in the sympathetic regulation of the insular cortex resulting in neurogenic stunned myocardium.

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Keywords : Apical ballooning, Limbic encephalitis, Stunned myocardium

Esquema

Case Report

Discussion

	Funding: None.
	Conflict of Interest: None.
	Authorship: All authors had access to the data. Drs. Gelow and Kaul were consultant cardiologists to the case. Drs. Kruer and Yadav took care of the patient. All assisted in writing the article and developing the figures.