Neurological Surgery No Shinkei Geka Volume 46, Issue 1 (January 2018)

Takotsubo Cardiomyopathy and Neurogenic Pulmonary Edema Following Fibrinolytic Therapy for Embolic Stroke:A Case Report Takehiro KITAGAWA 1,2 , Junkoh YAMAMOTO 1 , Makoto KURESHIMA 2 , Hitoshi MAEDA 2 , Shigeru NISHIZAWA 1 1Department of Neurosurgery, University of Occupational and Environmental Health 2Department of Neurosurgery, Kitakyushu General Hospital Keyword: neurogenic pulmonary edema , takotsubo cardiomyopathy , ischemic infarction , reperfusion injury , insular cortex pp.21-25
Published Date 2018/1/10
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 A 79-year-old man presented with left hemiparesis and disturbance of consciousness. Brain magnetic resonance(MR)imaging revealed an infarction in the right insular cortex. MR angiography showed a defect in the inferior trunk of the right middle cerebral artery. The patient was treated with alteplase about 2.5 h after onset. Immediately after the intravenous alteplase administration, the hemiparesis improved. However, his respiratory condition unexpectedly worsened 10 h after onset. Chest radiography demonstrated an infiltrative shadow in both lung fields. Transthoracic echocardiogram showed a dysfunction in the left ventricle and no contraction at the apex of the heart, consistent with a type of cardiomyopathy, known as takotsubo cardiomyopathy(TCM). Gradually, the patient's respiratory and cardiac function improved. Here, we describe a very rare case of TCM and neurogenic pulmonary edema(NPE)following an acute cerebral infarction, which was treated with alteplase intravenous administration. TCM and NPE have a poor prognosis, therefore diagnosis, management, and treatment in the acute phase is required.

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Neurological Surgery 脳神経外科
46巻1号 (2018年1月)
電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院