Reversible posterior leukoencephalopathy syndrome and takotsubo cardiomyopathy: the role of echocardiographic monitoring in the ICU

Abstract

We report a case of a female patient with acute renal failure due to polyarteritis nodosa. Her clinical course was initially complicated by an unusual form of hypertensive encephalopathy called reversible posterior leukoencephalopathy syndrome (RPLS). Soon afterwards she developed cardiogenic shock; she was intubated and admitted to our ICU. Echocardiography and pertinent laboratory data were suggestive of takotsubo cardiomyopathy (TTC), a rare form of stress-induced, reversible cardiac dysfunction. We hypothesized that TTC was pathophysiologically linked to RPLS, presumably through an overstimulation of the sympathetic nervous system. Both RPLS and TTC turned out to be totally reversible conditions, and intensive echocardiographic monitoring was of great importance in order to optimize the hemodynamic support in our patient.