てんかん発作ののち自覚症状を欠いてタコツボ型心筋症と心内血栓を呈した1例

A Case of Asymptomatic Takotsubo Cardiomyopathy with Intraventricular Thrombus Associated with Epileptic Seizure

はじめに

　タコツボ型心筋症（takotsubo cardiomyopathy：TC)¹⁾は高齢女性に多く，精神的・身体的ストレスを契機に発症し，冠動脈支配に一致しない左室心尖部の無収縮と心基部の代償性過収縮を示し，apical ballooningと呼ばれる壁運動異常をきたす。急性冠症候群と類似した臨床症状と心電図所見を呈するが，冠動脈造影上有意な狭窄を有さず，かつ壁運動は短期間で正常化することを特徴とする。発症機序は不明であるが，自律神経機能障害，カテコラミン過剰分泌が重要な役割を果たしていると考えられている。脳卒中など神経疾患後に生じるTCはneurogenic stunned myocardium²⁾という名で報告されることもある。

　われわれは，複雑部分発作2次性全般化発作ののちに自覚症状を欠いてTCをきたし，続いて心内血栓を生じた1例を経験した。てんかん発作後にTCが起こり得ることは十分に認知されているとはいえず今回報告した。

Abstract

　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 162/90mmHg and pulse of 126beats/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.

(Received: December 14,2010,Accepted: December 17,2010)