The Neurocardiogenic Spectrum in Subarachnoid Hemorrhage: A Case Report and Review of the Literature

Abstract

A 36-year-old man was brought to our emergency department after successful resuscitation of out-of-hospital cardiac arrest with the whole spectrum of neurocardiogenic effects in subarachnoid hemorrhage: electrocardiographic changes, regional wall motion abnormalities, and elevations of cardiac enzymes. Coronary angiography revealed normal coronary arteries but showed the midventricular type of Takotsubo cardiomyopathy in the left ventriculography. Subsequently, cerebral computed tomography revealed diffuse subarachnoid hemorrhage and generalized cerebral edema with brain herniation. Brain death was diagnosed. This case highlights the possibility of an acute cerebral illness (especially subarachnoid hemorrhage) as an underlying cause of cardiac abnormalities mimicking myocardial ischemia.

Successful Coil Embolization Using Percutaneous Cardiopulmonary Support in a Patient with Refractory Out-of-hospital Cardiac Arrest Caused by Aneurysmal Subarachnoid Hemorrhage

“… 14 – 16) Sudden cardiac arrest is an increasingly recognized presentation of TCM. 5 , 17 – 22) However, during ongoing CPR in the emergency department, accurately differentiating between comatose patients following SAH with TCM and ACS as a cause of OHCA is often challenging, especially those presenting with sudden collapse with no any prodromal symptoms or comorbidities. 1 , 20 , 22 , 23) Moreover, the initial cardiac rhythm of VF can be interpreted as an arrest of cardiac etiology because the cardiac rhythm was VF in only 0%–7.4% of cardiac arrest cases caused by SAH.…”

“… 5 , 17 – 22) However, during ongoing CPR in the emergency department, accurately differentiating between comatose patients following SAH with TCM and ACS as a cause of OHCA is often challenging, especially those presenting with sudden collapse with no any prodromal symptoms or comorbidities. 1 , 20 , 22 , 23) Moreover, the initial cardiac rhythm of VF can be interpreted as an arrest of cardiac etiology because the cardiac rhythm was VF in only 0%–7.4% of cardiac arrest cases caused by SAH. 5 , 10 , 18 , 23) In this setting, the prompt decision to initiate ECPR for our patient with refractory cardiac arrest of presumed cardiac etiology was made based on favorable prognostic factors including younger age, shockable initial cardiac rhythm, witnessed bystander CPR, short no-flow time, and transitory return of spontaneous circulation (ROSC) events.…”

Stress cardiomyopathy misinterpreted as ST-segment elevation myocardial infarction in a patient with aneurysmal subarachnoid hemorrhage: a case report

“…T-wave inversion, U waves, QT-interval prolongation, ST-segment depression are frequent findings in this setting, as opposed to abnormal Q-waves and ST-segment elevation [2,3]. The ECG changes may be accompanied by transient regional wall motion abnormalities (RWMA) and raised cardiac troponin (cTn) levels and have been referred to as "neurogenic cardiac stunning", "neurogenic stress cardiomyopathy" (NSC), "neurogenic stunned myocardium" (NSM) or "Takotsubo cardiomyopathy" (TC) [4,5].…”