たこつぼ型心筋症の回復期に脳塞栓症を来した1例

A Case of Cerebral Infarction caused by Embolism of a Left Ventricular Thrombus associated with the Recovery Phase of Takotsubo-cardiomyopathy

要旨　患者は76歳，女性．胸部圧迫感を主訴に当院受診．受診時の心電図にてST上昇を認め，急性心筋梗塞が疑われたため冠動脈造影施行．冠動脈造影では有意狭窄を認めなかったが，心臓超音波検査では心基部の過収縮および心尖部の無収縮像を認め，たこつぼ型心筋症と診断した．カルシウム拮抗薬，利尿剤にて加療開始し，第4病日に心臓超音波検査にて壁運動の改善を認めたが，同日右片麻痺および意識レベルの低下を認めた．緊急脳血管造影では，左中大脳動脈末梢閉塞を認め血栓溶解療法施行．再疎通に成功し，意識レベルは改善した．今回の脳塞栓症の原因としては心原性の血栓性閉塞が考えられた．

Summary

　A 76-year-old woman with angina pectoris was admitted to our hospital because of chest discomfort. An electrocardiogram showed ST elevation, T-wave inversion and sinus tachycardia. Emergency coronary angiography revealed no significant stenosis.

　Echocardiography revealed akinesis of the left ventricular apex and basal hypercontraction of the left ventricle. We diagnosed Takotsubo-cardiomyopathy, and medicated it with a calcium antagonist. However, on the 4th hospital day, the patient suddenly developed right hemiparesis.

　Cerebralangiography showed total occlusion of the left middle cerebral artery, but thrombolytic therapy was effective. After the thrombolysis, she recovered consciousness and her right hemiparesis was completely cured. We speculated that a cerebral infarction during her clinical course was caused by embolism of a left ventricular thrombus associated with the recovery phase of takotsubo-cardiomyopathy.