Stress cardiomyopathy associated with the first manifestation of multiple sclerosis: a case report.
Case report
Multiple sclerosis
Serum NfL
Stress cardiomyopathy
Takotsubo cardiomyopathy
Journal
BMC neurology
ISSN: 1471-2377
Titre abrégé: BMC Neurol
Pays: England
ID NLM: 100968555
Informations de publication
Date de publication:
04 Jun 2020
04 Jun 2020
Historique:
received:
22
03
2020
accepted:
30
04
2020
entrez:
6
6
2020
pubmed:
6
6
2020
medline:
23
9
2020
Statut:
epublish
Résumé
We present a case with a close temporal association of the first diagnosis of multiple sclerosis and stress cardiomyopathy. A 19-year-old man experienced severe dyspnoea. The cardiac biomarkers troponin T and NT-proBNP were elevated, and transthoracic echocardiography showed basal hypokinesia. The man was diagnosed with stress cardiomyopathy after main differential diagnoses such as acute coronary syndrome, myocarditis, and pheochromocytoma were excluded. Furthermore, the patient reported vertigo and paraesthesia. Brain and spinal MRI revealed T2-hyperintense lesions with a prominent acute lesion in the pontomedullary area. Cerebrospinal fluid findings revealed a lymphocytic pleocytosis and intrathecal IgG synthesis. Serum neurofilaments were elevated. The patient was diagnosed with MS, and treatment with intravenous Methylprednisolone was initiated. The brainstem lesion due to multiple sclerosis was assumed to be the cause of stress cardiomyopathy. The patient fully recovered. Stress cardiomyopathy may be linked with the first manifestation of multiple sclerosis in the presented case since pontomedullary lesions could affect the sympathetic nervous system. This case highlights the importance of neurological history and examination in young patients with unexplained acute cardiac complaints.
Sections du résumé
BACKGROUND
BACKGROUND
We present a case with a close temporal association of the first diagnosis of multiple sclerosis and stress cardiomyopathy.
CASE PRESENTATION
METHODS
A 19-year-old man experienced severe dyspnoea. The cardiac biomarkers troponin T and NT-proBNP were elevated, and transthoracic echocardiography showed basal hypokinesia. The man was diagnosed with stress cardiomyopathy after main differential diagnoses such as acute coronary syndrome, myocarditis, and pheochromocytoma were excluded. Furthermore, the patient reported vertigo and paraesthesia. Brain and spinal MRI revealed T2-hyperintense lesions with a prominent acute lesion in the pontomedullary area. Cerebrospinal fluid findings revealed a lymphocytic pleocytosis and intrathecal IgG synthesis. Serum neurofilaments were elevated. The patient was diagnosed with MS, and treatment with intravenous Methylprednisolone was initiated. The brainstem lesion due to multiple sclerosis was assumed to be the cause of stress cardiomyopathy. The patient fully recovered.
CONCLUSION
CONCLUSIONS
Stress cardiomyopathy may be linked with the first manifestation of multiple sclerosis in the presented case since pontomedullary lesions could affect the sympathetic nervous system. This case highlights the importance of neurological history and examination in young patients with unexplained acute cardiac complaints.
Identifiants
pubmed: 32498673
doi: 10.1186/s12883-020-01757-6
pii: 10.1186/s12883-020-01757-6
pmc: PMC7271507
doi:
Substances chimiques
Biomarkers
0
Peptide Fragments
0
Troponin T
0
pro-brain natriuretic peptide (1-76)
0
Natriuretic Peptide, Brain
114471-18-0
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
227Références
Ann Neurol. 2017 May;81(5):754-758
pubmed: 28437859
J Neurol Neurosurg Psychiatry. 2019 Feb;90(2):157-164
pubmed: 30309882
Eur Heart J. 2018 Jun 7;39(22):2032-2046
pubmed: 29850871
Lancet Neurol. 2018 Feb;17(2):162-173
pubmed: 29275977
Mult Scler. 2015 Mar;21(3):318-31
pubmed: 25533300
Mult Scler. 2016 May;22(6):842-6
pubmed: 26993120
Nat Rev Neurol. 2018 Oct;14(10):577-589
pubmed: 30171200
Mult Scler Relat Disord. 2019 May;30:292
pubmed: 30987753
Circulation. 2007 Jul 3;116(1):77-84
pubmed: 17606855