A Case of Posterior Reversible Encephalopathy Due to Takotsubo Cardiomyopathy Triggered by Aerophobia

Abstract

A 37-year-old woman, previously known to have severe airplane phobia, develops panic disorder-like symptoms in the second hour of the flight. After a while, panic disorder was accompanied by chest pain and syncope. An ECG showed no abnormalities. Transthoracic echocardiogram demonstrated decreased left ventricular ejection fraction (EF: 30), large apical akinesis, and characteristic regional wall motion abnormalities involving the middle and apical segments of the left ventricle. Findings were consistent with Takotsubo cardiomyopathy. But in the emergency department, Brain Diffusion MRI showed cortical and subcortical vasogenic edema in the posterior regions, predominantly on the left, bilaterally, compatible with posterior reversible encephalopathy. This case highlights the Takotsubo cardiomyopathy-related posterior reversible encephalopathy syndrome (PRES) syndrome and managing the disease.

Keywords: heart failure; loss of conciousness; posterior reversible encephalopathy syndrome (pres); tako-tsubo cardiomyopathy (ttc); unexplained syncope.

Figure 1. Axial diffusion-weighted magnetic resonance imaging showed prominent bilateral hyperintensity on the posterior regions of the brain's left side consistent with posterior reversible encephalopathy.

Figure 2. Epileptiform activity was not observed on the EEG