Takotsubo cardiomyopathy and cerebral infarction

Takotsubo cardiomyopathy is reversible left ventricular dysfunction and apical ballooning resembling acute myocardial infarction. Although Takotsubo cardiomyopathy is a well-known complication of subarachnoid hemorrhage, it is rare in patients with acute cerebral infarction. We reviewed the findings of thirty previously published cases with both Takotsubo cardiomyopathy and cerebral infarction. These cases were divided into three groups (A-C) according to etiology. A; Dysfunction of central autonomic network associated with cerebral infarction caused Takotsubo cardiomyopathy, B; Left ventricular thrombus associated with Takotsubo cardiomyopathy caused cardioembolic stroke. C; The unknown relation of cause and effect. Most patient were elderly women in all groups. Group A mostly included the territory of middle cerebral artery or basilar artery as the infarcts area. The cardiomyopathy in group A often occurred within 24 hours after stroke onset and was commonly asymptomatic. On the other hand, the cardiomyopathy in group B often was commonly symptomatic. But some cases with mild cardiac symptom in group B was diagnosed by embolic event. Takotsubo cardiomyopathy can notably be both the cause and effect of stroke. The 'chicken or egg' issue regarding stroke etiology in group C is sometimes not simple to resolve.