Basal type Takotsubo Syndrome in the post-ictal period – A case report highlighting the importance of post-ictal cardiac evaluation

Abstract

Takotsubo syndrome (TTS) is a reversible form of left ventricular dysfunction commonly associated with physical or emotional stress. It is characterised by chest pain and elevated troponin levels, thereby mimicking acute coronary syndrome however there is typically no evidence of obstructive coronary artery disease on invasive angiography. TTS is characterised by apical ballooning or akinesis with basal hyperkinesia. Basal type Takotsubo Syndrome (bTTS) is a less common atypical variant identified by basal akinesis and apical hyperkinesis. Although both forms have been shown to be associated with neurological disease and intracranial haemorrhage or ischaemic stroke, bTTS in the context of epileptiform seizures is relatively rare but an important diagnosis to recognise. We describe a case of a 73-year-old woman who presented to hospital with generalised tonic clonic seizures, followed by centralised chest pain, troponin elevation due to bTTS. This case describes an uncommon presentation of bTTS and highlights the importance of cardiac assessment in patients presenting with generalised tonic-clonic seizures.