ABSTRACT
BACKGROUND: Central nervous system diseases are common triggers of Takotsubo syndrome. We herein report a rare case of Takotsubo syndrome associated with autoimmune limbic encephalitis. CASE PRESENTATION: A 68-year-old Japanese woman presented to our emergency room with disturbed consciousness. At admission, she showed hypoxemia. Left ventriculography showed akinesia in the middle part of the left ventricle and hyperkinesia in the apical and basal parts of the left ventricle, and the diagnosis of midventricular Takotsubo syndrome was established. However, after an improvement in disturbed consciousness and Takotsubo syndrome symptoms, her brother noticed something wrong with her behavior during his visit to the hospital. Subsequently, we consulted the neurology department 1 week after admission. Her brother revealed a history of abnormal behavior by the patient (such as mistaken entry in the wrong apartment in her building or in another person's car) a few days prior to the onset of disturbed consciousness, suggesting disorientation of place. Brain magnetic resonance imaging showed an increased signal in the medial aspect of the temporal lobes, which was most clearly observed on the fluid-attenuated inversion recovery sequence; additionally, a cerebrospinal fluid analysis revealed mild lymphocytic pleocytosis. Finally, we established a diagnosis of midventricular Takotsubo syndrome associated with autoimmune limbic encephalitis. CONCLUSIONS: It is presumed that the dysfunction of limbic system due to autonomic limbic encephalopathy is associated with exaggerated sympathetic stimulation. This likely resulted in Takotsubo syndrome in our patient.
Subject(s)
Autoimmune Diseases/complications , Limbic Encephalitis/complications , Takotsubo Cardiomyopathy/etiology , Ventricular Function, Left , Aged , Autoimmune Diseases/diagnosis , Autoimmune Diseases/physiopathology , Autoimmune Diseases/therapy , Diffusion Magnetic Resonance Imaging , Electrocardiography , Electroencephalography , Female , Humans , Limbic Encephalitis/diagnosis , Limbic Encephalitis/physiopathology , Limbic Encephalitis/therapy , Perfusion Imaging , Predictive Value of Tests , Radionuclide Ventriculography , Takotsubo Cardiomyopathy/diagnosis , Takotsubo Cardiomyopathy/physiopathology , Takotsubo Cardiomyopathy/therapy , Tomography, Emission-Computed, Single-PhotonABSTRACT
We examined the correlations between cerebrospinal fluid (CSF) concentrations of homovanillic acid (HVA) and 5-hydroxyindole acetic acid (5-HIAA) and imaging assessment scores, using 123I-Ioflupane SPECT and 123I-MIBG myocardial scintigraphy in 23 drug naïve PD patients. The CSF 5-HIAA concentration correlated with the H/M ratio of the delayed image (r = 0.458, p < 0.05) and the washout rate (r = - 0.642, p < 0.01) of 123I-MIBG myocardial scintigraphy. These correlations suggest some unclarified pathophysiological links between the central serotonergic and cardiac sympathetic systems.
Subject(s)
3-Iodobenzylguanidine/pharmacokinetics , Hydroxyindoleacetic Acid/cerebrospinal fluid , Iodine Radioisotopes/pharmacokinetics , Myocardial Perfusion Imaging , Myocardium/metabolism , Nortropanes/pharmacokinetics , Parkinson Disease/metabolism , Radiopharmaceuticals/pharmacokinetics , Tomography, Emission-Computed, Single-Photon , Aged , Aged, 80 and over , Autonomic Fibers, Postganglionic/metabolism , Biomarkers , Cognitive Dysfunction/etiology , Dementia/etiology , Female , Heart Conduction System/physiopathology , Homovanillic Acid/cerebrospinal fluid , Humans , Male , Middle Aged , Organ Specificity , Parkinson Disease/cerebrospinal fluid , Parkinson Disease/psychology , Serotonin/metabolismABSTRACT
A 66-year-old man presented with a disturbed consciousness and seizure-like movements, followed by the initial symptoms of herpes zoster. Immunoglobulin (Ig) M antibodies to varicella zoster virus (VZV) as well as herpes simplex virus (HSV) were positive in the cerebrospinal fluid (CSF), whereas polymerase chain reaction of the CSF was positive for VZV-DNA but negative for HSV-DNA. The serum/CSF IgM ratio for VZV and HSV increased in association with a clinical improvement. This is a case report of a rare case of VZV encephalitis demonstrating false-positive results for IgM to HSV in the CSF. The increase in the serum/CSF IgM ratio possibly reflects a recovery from blood-brain barrier breakdown.
Subject(s)
Encephalitis, Viral/virology , Herpesvirus 3, Human/immunology , Immunoglobulin M/immunology , Simplexvirus/immunology , Aged , Cerebrospinal Fluid , Diagnosis, Differential , False Positive Reactions , Humans , Male , Polymerase Chain ReactionABSTRACT
Marchiafava-Bignami disease is a rare alcohol-associated disorder. Clinical features include not only disturbed consciousness, dysarthria, tetraparesis, and astasia-abasia as initial symptom but also cognitive deficits and symptoms of interhemispheric disconnection as clinical outcomes. The clinical significance of cerebral microhemorrhage has been recognized in patients with cognitive deficits. We have recently examined the clinical significance of cerebral microhemorrhage in Marchiafava-Bignami disease and demonstrated that demented patients showed higher severity of cerebral microhemorrhage than patients with normal cognitive function. However, the relationship between callosal lesions and cerebral microhemorrhage in Marchiafava-Bignami disease has not been fully examined. The aim of the present study was to clarify the relationship between callosal lesions and cerebral microhemorrhage in Marchiafava-Bignami disease. For this purpose, we report four patients with Marchiafava-Bignami disease. All cases had a history of chronic alcohol abuse and symmetrical lesions in the corpus callosum. Clinical symptoms include not only coma, dysarthria, and astasia-abasia as initial symptom but also dementia as clinical outcomes. Susceptibility-weighted imaging showed asymmetrical hypointense areas in the multiple cortico-subcortical regions, indicating the presence of cerebral microhemorrhage. There were no apparent relationships between the extension of callosal lesion and the severity of cognitive deficits or cerebral microhemorrhage. Our present report indicates that cerebral microhemorrhage, an important. factor for the severity of dementia in Marchiafava-Bignami disease as clinical outcomes, is independent of the callosal lesion.
