Neurogenic stunned myocardium associated with reversible posterior leukoencephalopathy syndrome

Abstract

Introduction: Neurogenic stunned myocardium is characterized by transient left ventricular systolic dysfunction in the absence of significant obstructive coronary artery disease. Reversible posterior leukoencephalopathy syndrome (RPLS) is characterized by transient vasogenic subcortical edema without infarction. Both syndromes are hypothesized to result from sympathetic dysregulation. We report a case of neurogenic-stunned myocardium and RPLS occurring simultaneously in a patient.

Methods: Single case report.

Results: We present a 55-year-old woman with a history of hypertension and chronic back pain status post spinal cord stimulator who presented with severe headache, seizure, and confusion associated with acute hypertension. Magnetic resonance imaging (MRI) of the brain revealed bilateral patchy T(2) signal hyperintensity, consistent with RPLS. Transthoracic echocardiogram (TTE) showed regional-wall motion abnormalities in the apical regions, consistent with neurogenic-stunned myocardium. The patient's TTE and MRI abnormalities resolved on follow-up studies.

Conclusion: Neurogenic-stunned myocardium and RPLS are two reversible clinical syndromes that are hypothesized to be a result of sympathetic dysregulation. Our case suggests that these two syndromes may occur together in the same patient.