The frequent occurrence of a reversible left ventricular dysfunction complicating subarachnoid haemorrhage raises a number of issues about the clinical and pathophysiological similarities with the transient left ventricular apical ballooning syndrome (TLVABS) or tako-tsubo cardiomyopathy (TTC). Given the latest clinical and pathophysiological evidence about neurogenic cardiomyopathies, the diagnosis of TTC should not be ruled out in patients experiencing acute brain injury and cerebrovascular events. Each type of reversible left ventricular dysfunction mediated by the central nervous system and initiated by acute brain injury, both physical, such as intracranial bleeding or head traumas, and psychological, such as sudden emotional stress, could be encompassed in a single definition with larger inclusion criteria, such as 'acute ballooning cardiomyopathy' (ABC), that is likely to be more representative of the real needs in the clinical setting.

Neurogenic cardiomyopathies are raising a growing interest due to their multidisciplinary implications. Despite the body of literature, questions about pathophysiology, risk predictors and prognosis of the various clinical pictures are still open. The frequent observation of a reversible left ventricular dysfunction complicating subarachnoid haemorrhage drops several hints of discussion about the clinical and pathophysiological similarities with the 'typical' transient left ventricular apical ballooning syndrome. In the light of the latest clinical and pathophysiological evidences, transient left ventricular apical ballooning syndrome could no longer be considered as an exclusively 'apical' wall motion abnormality and this diagnosis had not to be ruled out in patients experiencing acute brain injury and cerebrovascular events. Each kind of reversible left ventricular dysfunction mediated by the central nervous system and initiated by acute brain injury, both physical, like intracranial bleeding or head traumas, and psychical, like sudden emotional stress, could be encompassed in a single definition with wider inclusion criteria, such as 'acute ballooning cardiomyopathy' (ABC), that is likely to be more representative of the real needs in the clinical setting.

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