Neurogenic Stunned Myocardium in Two Children with Neurological Injury

Abstract

Neurogenic stunned myocardium is described as sudden and reversible cardiac dysfunction induced by an acute neurological event. This phenomenon has not been thoroughly investigated in infants, and is probably underdiagnosed. Here, we report the cases of two infants with neurogenic stunned myocardium in whom the clinical suspicion was relevant, with a brief discussion of this condition.

Keywords

neurogenic stunned myocardium - cardiac dysfunction - physical child abuse

• References

• 1 Krishnamoorthy V, Mackensen GB, Gibbons EF, Vavilala MS. Cardiac dysfunction after neurologic injury: what do we know and where are we going?. Chest 2016; 149 (05) 1325-1331
• 2 Paur H, Wright PT, Sikkel MB. , et al. High levels of circulating epinephrine trigger apical cardiodepression in a β2-adrenergic receptor/Gi-dependent manner: a new model of Takotsubo cardiomyopathy. Circulation 2012; 126 (06) 697-706
• 3 Surikow SY, Raman B, Licari J, Singh K, Nguyen TH, Horowitz JD. Evidence of nitrosative stress within hearts of patients dying of Tako-tsubo cardiomyopathy. Int J Cardiol 2015; 189: 112-114
• 4 Murthy SB, Shah S, Rao CP, Bershad EM, Suarez JI. Neurogenic stunned myocardium following acute subarachnoid hemorrhage: pathophysiology and practical considerations. J Intensive Care Med 2015; 30 (06) 318-325
• 5 Brevis Nuñez F, Tschiedel E, Felderhoff-Mueser U, Neudorf U, Chapot R, Dohna-Schwake C. Neurogenic stunned myocardium after embolization in two children with vein of Galen aneurysmal malformation. Neuroradiology 2013; 55 (02) 213-216
• 6 Drayer M, Geracht J, Madikians A, Harrison R. Neurogenic stunned myocardium: an unusual postoperative complication. Pediatr Crit Care Med 2006; 7 (04) 374-376
• 7 Johnson J, Ragheb J, Garg R, Patten W, Sandberg DI, Bhatia S. Neurogenic stunned myocardium after acute hydrocephalus. J Neurosurg Pediatr 2010; 5 (05) 428-433
• 8 Kida K, Akashi YJ, Fazio G, Novo S. Takotsubo cardiomyopathy. Curr Pharm Des 2010; 16 (26) 2910-2917
• 9 Bybee KA, Prasad A. Stress-related cardiomyopathy syndromes. Circulation 2008; 118 (04) 397-409
• 10 Lyon AR, Bossone E, Schneider B. , et al. Current state of knowledge on Takotsubo syndrome: a Position Statement from the Taskforce on Takotsubo Syndrome of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2016; 18 (01) 8-27
• 11 Scally C, Rudd A, Mezincescu A. , et al. Persistent long-term structural, functional, and metabolic changes after stress-induced (Takottsubo) cardiomyopathy. Circulation 2018; 137 (10) 1039-1048
• 12 Schwarz K, Ahearn T, Srinivasan J. , et al. Alterations in cardiac deformation, timing of contraction and relaxation, and early myocardial fibrosis accompany the apparent recovery of acute stress-induced (Takotsubo) cardiomyopathy: an end to the concept of transience. J Am Soc Echocardiogr 2017; 30 (08) 745-755
• 13 Bulsara KR, McGirt MJ, Liao L. , et al. Use of the peak troponin value to differentiate myocardial infarction from reversible neurogenic left ventricular dysfunction associated with aneurysmal subarachnoid hemorrhage. J Neurosurg 2003; 98 (03) 524-528
• 14 Nguyen TH, Neil CJ, Sverdlov AL. , et al. N-terminal pro-brain natriuretic protein levels in takotsubo cardiomyopathy. Am J Cardiol 2011; 108 (09) 1316-1321
• 15 Ono R, Falcão LM. Takotsubo cardiomyopathy systematic review: pathophysiologic process, clinical presentation and diagnostic approach to Takotsubo cardiomyopathy. Int J Cardiol 2016; 209 (209) 196-205
• 16 Varvarousi G, Xanthos T, Sarafidou P. , et al. Role of levosimendan in the management of subarachnoid hemorrhage. Am J Emerg Med 2016; 34 (02) 298-306
• 17 Busani S, Rinaldi L, Severino C, Cobelli M, Pasetto A, Girardis M. Levosimendan in cardiac failure after subarachnoid hemorrhage. J Trauma 2010; 68 (05) E108-E110
• 18 Papanikolaou J, Tsolaki V, Makris D, Zakynthinos E. Early levosimendan administration may improve outcome in patients with subarachnoid hemorrhage complicated by acute heart failure. Int J Cardiol 2014; 176 (03) 1435-1437
• 19 Llorens-Soriano P, Carbajosa-Dalmau J, Fernández-Cañadas J. , et al. [Clinical experience with levosimendan in the emergency department of a tertiary care hospital]. Rev Esp Cardiol 2007; 60 (08) 878-882