Severe Biventricular Takotsubo Syndrome Triggered by Status Epilepticus With Pulmonary Embolism and Critical Illness Myopathy.

BACKGROUND

Takotsubo syndrome is a reversible stress-induced cardiomyopathy that frequently mimics acute coronary syndrome and is precipitated by intense emotional, neurologic, or physiologic stress.

CASE SUMMARY: An 81-year-old woman presented with generalized tonic-clonic seizure and subsequently developed nonconvulsive status epilepticus, cardiogenic shock, and severe biventricular systolic dysfunction with a left ventricular ejection fraction of <20%, later recovering to 55% to 60%. Her hospital course was complicated by subsegmental pulmonary embolism, hypoxic respiratory failure, metabolic encephalopathy, and prolonged intensive care unit stay requiring inpatient rehabilitation for critical illness myopathy.

DISCUSSION: Research describes clear associations between Takotsubo syndrome and seizures, although the true prevalence is unclear. This case illustrates Takotsubo as a consequence of neurologic stress, underscoring the importance of early cardiac evaluation.

TAKE-HOME MESSAGES: Takotsubo syndrome should be considered in patients with status epilepticus who develop hemodynamic deterioration. These patients need serial reassessment during recovery because severe neurologic illness may evolve into a prolonged multisystem critical illness.