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Abstract:
We report the case of a 77-year-old woman who had a coincidence of transient global amnesia (TGA) and takotsubo cardiomyopathy (syn. stress-induced cardiomyopathy) without preceding stressful event.
The patient was admitted to our emergency room because of an acute onset of amnesia, vertigo, nausea and vomiting. The clinical examination revealed anterograde amnesia without further abnormalities. MRI of the brain was performed, because the beginning of symptoms hasn’t been witnessed. It showed two small DWI lesions in the left hippocampus. The amnestic episode resolved completely after several hours. Finally the diagnosis of transient global amnesia was made.
Because of an elevated troponine and creatine kinase echocardiography was performed, showing apical akinesia of the left ventricle. Treatment with acetylsalicylic acid, heparin and a beta-blocker was started. Echocardiography after 1 week showed improvement and after 4 weeks complete resolution of the apical akinesia. These findings are consistent with takotsubo cardiomyopathy.
These two diseases share common aspects regarding their trigger factor, i.e. stressful event (intense emotional or physical stress). Both are usually reversible. They have to be distinguished from acute stroke especially in the posterior circulation, epileptic seizures and myocardial infarction. In our case the causality remains unclear. TGA and TTCM could have had a common trigger or one could have triggered the other.