[A case of asymptomatic takotsubo cardiomyopathy with intraventricular thrombus associated with epileptic seizure].

A 69-year-old woman was admitted to our department for consciousness disturbance with generalized clonic seizure. She had a history of complex partial seizure with automatism 3 years previously, but had not received any antiepileptic drug therapy. On admission, she was unconscious with a Japan Coma Scale of 200. Physical examination demonstrated a blood pressure of 162/90 mm Hg and pulse of 126 beats/min. Neurological examination did not detect any focal findings. Four hours later, she was conscious and antiepileptic drug therapy was initiated. Twenty-six hours post admission, ECG monitoring showed giant T-wave inversion, but cardiac symptoms were absent. Echocardiography showed apical ballooning of the left ventricle. Echocardiography on day 6 demonstrated a thrombus at the apex of the left ventricle. Anticoagulant therapy was started immediately. Echocardiography on day 14 showed that the left ventricular apical asynergy had completely resolved, and the thrombus had disappeared. Takotsubo cardiomyopathy could be a complication of epilepsy. It occurs most often soon after epileptic seizure, rarely occurs with a time lag and is asymptomatic as in the present case. ECG monitoring after epileptic seizure is useful for prompt detection and treatment of takotsubo cardiomyopathy.