Describe transient global amnesia (TGA) associated with Takotsubo cardiomyopathy (TTC).

TGA is characterized by sudden onset of anterograde amnesia, lasting up to 24 hours, without other neurological deficits. Its etiology remains unclear, with multiple proposed mechanisms, including arterial ischemia, venous congestion, migraine, and psychogenic disorders.  TTC is characterized by transient left ventricular (LV) dysfunction in patients with normal coronary arteries. TTC is an increasingly recognized complication of neurological disorders, likely mediated by sympathetic overactivity. 

We report two cases of TGA associated with TTC and review the literature.

Two female patients aged 74(case 1) and 72(case 2) years-old, presented with anterograde amnesia and no other neurological deficits. Upon presentation, both patients were hypertensive and reported recent emotional stress. Symptoms resolved within 24 hours, consistent with TGA. Brain magnetic resonance imaging was unremarkable in case 1, but it showed a tiny acute pons infarct in case 2.  Electroencephalograms were normal. Electrocardiogram showed T-wave inversions in V3-V6 in case 1, and it was normal in case 2. In both cases, investigations revealed elevated troponin, and the transthoracic echocardiogram (TTE) showed LV apical hypokinesis, consistent with TTC. Pharmacologic nuclear stress test showed no ischemia. Repeat TTE 6 months later confirmed resolution of the wall motion abnormalities.  Seven additional cases of TGA associated with TTC have been described in the literature.

TGA and TTC share common features such as onset in the sixth decade, gender predilection towards women, reversible natural history, and stress as a precipitant. Our cases support the hypothesis that both conditions share the same pathophysiology, with sympathetic overactivity playing a central role. Concurrent TGA and TTC may occur as a result of a catecholaminergic surge, resulting in cerebral venous congestion and cardiotoxicity.   An increase in awareness of the association between these conditions may lead to an earlier recognition and appropriate treatment.