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Int J Cardiol. 2013 Sep 10;167(6):2441-8. doi: 10.1016/j.ijcard.2013.01.031. Epub 2013 Feb 13.

Stress cardiomyopathy (tako-tsubo) triggered by nervous system diseases: a systematic review of the reported cases.

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  • 1Cardiovascular and Neurological Department, Ospedale San Donato, Arezzo, Italy. italo.porto@gmail.com



It is not clarified whether the transient, regional left ventricular dysfunction (TRLVD) associated with several neurological disorders shares the same pathophysiology with the classical tako-tsubo cardiomyopathy occurring without overt neurological disease, and whether it is appropriate to include these patients in a single stress cardiomyopathy (SCM) condition.


In February 2012, we systematically explored major electronic medical information sources to identify cases of TRLVD triggered by neurological disorders.


The 81 selected papers reported a total of 124 patients, suffering from neurological disorders, in whom TRLVD occurred: 117 with central nervous system diseases, 6 with peripheral nervous system diseases and 1 with both systems involved. Most patients were females (n=102), mean age was 63 ± 15 years, and the majority presented with an apex-involving pattern. The most common disease described was subarachnoid hemorrhage (n=52), followed by stroke/transient ischemic attack (n=24), and seizures (n=18). TRLVD in neurological patients was often associated with need of inotropic support, orotracheal intubation, cerebrovascular spasm and delayed surgery.


TRLVD is a complication of neurological diseases, in particular in female patients in post-menopausal phase. The predilection for neurological damage at or close to the insular cortex highlights the pivotal role of sympathetic over-activation. Many other similarities with tako-tsubo support the inclusion in a single SCM category.

Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.


Nervous system disease; Stress cardiomyopathy; Tako-tsubo

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