J Clin Neurol.  2010 Sep;6(3):152-155. 10.3988/jcn.2010.6.3.152.

Takotsubo Cardiomyopathy Following Cerebral Infarction Involving the Insular Cortex

• Cho HJ
• Kim HY
• Han SH
• Kim HJ
• Moon YS
• Oh J

• KMID: 1462852
• DOI: http://doi.org/10.3988/jcn.2010.6.3.152

Abstract

BACKGROUND
Takotsubo cardiomyopathy is characterized by clinical features similar to those of acute myocardial ischemia, but without angiographic evidence of obstructive coronary artery disease. We present a patient with takotsubo cardiomyopathy following acute infarction involving the left insular cortex.
CASE REPORT
A 52-year-old man was admitted with acute infarction of the left middle cerebral artery territory and acute chest pain. Acute myocardial infarction was suspected because of elevated serum troponin levels and hypokinesia of the left ventricle on echocardiography. However, a subsequent coronary angiography revealed no stenosis within the coronary arteries or ballooning of the apical left ventricle.
CONCLUSIONS
We postulated that catecholamine imbalance due to the insular lesion could be responsible for these interesting features.

Keyword

takotsubo cardiomyopathy; insula; infarction

MeSH Terms

Cerebral Infarction
Chest Pain
Constriction, Pathologic
Coronary Angiography
Coronary Artery Disease
Coronary Vessels
Echocardiography
Heart Ventricles
Humans
Hypokinesia
Infarction
Middle Aged
Middle Cerebral Artery
Myocardial Infarction
Myocardial Ischemia
Takotsubo Cardiomyopathy
Troponin
Troponin

Figure

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  Fig. 1 Brain magnetic resonance image and angiography of the patient. A: Acute infarction of the middle cerebral artery territory involving the left insular cortex. B and C: No significant stenosis was noted in relevant arteries on magnetic resonance angiography.

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  Fig. 2 Electrocardiography showing atrial fibrillation with ST-segment elevation at leads I, aVL, and V2-5, suggesting acute anterolateral wall ischemia.

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  Fig. 3 Echocardiography showing hypokinesia of the middle and apical walls of the left ventricle (A); no stenotic lesion was found on coronary angiography (B). Note the characteristic appearance of "apical ballooning" on the left ventriculogram (C), which is similar to that of a takotsubo, a Japanese octopus-trapping pot.

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