Two pediatric cases of variant neurogenic stress cardiomyopathy after intracranial hemorrhage

Pediatrics
Samuel G WittekindEdward F Gibbons

Abstract

Takotsubo cardiomyopathy, also known as stress-induced cardiomyopathy, is an acquired form of left ventricular systolic dysfunction seen in the setting of physiologic stress and the absence of coronary artery disease. It is thought to be caused by excessive sympathetic stimulation. It is well described in the adult literature associated with subarachnoid hemorrhage where it is known as neurogenic stress cardiomyopathy (NSC), but few such pediatric cases have been reported. We describe our experience with 2 children (13- and 10-year-old girls) who presented with spontaneous intracranial hemorrhage followed by pulmonary edema and shock. Echocardiography revealed similar patterns of left ventricular wall motion abnormalities consistent with NSC, inverted Takotsubo variant. One child progressed to death, whereas the other made a remarkable recovery, including significant improvement in cardiac function over the course of 1 week. We argue that at least 1 of these cases represents true stress-induced cardiomyopathy. This report will alert pediatricians to this transient cardiomyopathy that is likely underdiagnosed in pediatric intensive care. We also highlight the challenges of managing both shock and elevated intracranial pressure i...Continue Reading

Citations

Dec 3, 2014·International Journal of Cardiology·Josef Finsterer, Claudia Stöllberger
Aug 19, 2015·Cardiology in the Young·Nayan T SrivastavaRoger A Hurwitz
Feb 3, 2016·Chest·Vijay KrishnamoorthyMonica S Vavilala
May 18, 2016·Revista Portuguesa De Cardiologia : Orgão Oficial Da Sociedade Portuguesa De Cardiologia = Portuguese Journal of Cardiology : an Official Journal of the Portuguese Society of Cardiology·Joana Faleiro OliveiraHelena Almeida
Sep 28, 2016·Journal of Cardiovascular Medicine·Alessia UrbinatiAndrew L Clark
Jul 5, 2017·World Journal for Pediatric & Congenital Heart Surgery·Robert Dalla PozzaB Heineking
Apr 20, 2019·Journal of Neurosurgery. Pediatrics·Gabriel Crevier-SorboRoy W R Dudley
Aug 15, 2019·BMC Pediatrics·Kristy Xinghan FuMelissa Hui Xin Chua
Feb 24, 2021·Child's Nervous System : ChNS : Official Journal of the International Society for Pediatric Neurosurgery·Junji KoyamaAtsufumi Kawamura

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