Neurogenic Stunned Myocardium in Subarachnoid Hemorrhage

Daniel Bergeron, John Evans, Stephen Dixon

Abstract


Neurogenic stunned myocardium is a triad of reversible left ventricular dysfunction, electrocardiogram changes and elevation of cardiac enzymes. Clinically, this provides diagnostic challenges in the setting of subarachnoid hemorrhage (SAH) due to the diagnostic uncertainty. The pathophysiological mechanisms for neurogenic stunned myocardium have included hypothalamic and myocardial perivascular lesions. More recently, alternative research has focused on myocardial microvascular dysfunction and genetic polymorphisms. Management has remained largely supportive with case reports citing the benefits of inotropes and intra-aortic balloon pumps in the setting of cardiogenic shock complicating NSM. When NSM follows SAH there are numerous complications, including pulmonary edema, arrhythmias and prolonged intubation, which can impact outcomes and increase morbidity and mortality. This highlights the need for accurate and timely diagnosis of NSM which has remained a clinical challenge.
We report a case of a 52-year-old patient who presented to the ICU with complaints of atypical chest pain without neurologic complaints or lateralizing symptoms. She was admitted to the ICU for ongoing chest pain with concurrent ECG T-wave inversions. Within 24 hours she developed lateralizing neurologic signs and altered mental status with subsequent imaging revealing evidence of a SAH. We describe characteristics and outcomes of NSM in this patient with aneurysmal associated SAH.

Keywords


Neurogenic stunned myocardium, subarachnoid hemorrhage

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References


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