Abstract Details

Title Takotsubo Cardiomyopathy Presenting During an Epilepsy Monitoring Unit Admission: a Possible Fatal Complication

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) P10 - Poster Session 10 (5:00 PM-6:00 PM)

Poster/Presentation
Number 9-012

Objective To describe a case of Takotsubo cardiomyopathy (TTC) after a seizure to highlight a potential cardiac risk factor during an epilepsy monitoring unit (EMU) admission.

Background Epileptic seizure induced TTC has been described in over a hundred cases in literature. However, no case has been reported of TTC in a young female with no prior history of cardiovascular risk factors during an EMU admission. The identification and diagnosis of TTC after a seizure can often be limited by postictal somnolence or lack of cardiologic surveillance.

Design/Methods Case report.

Results A 27-year-old right-handed female presented to a tertiary care center for management of her medically refractory epilepsy. The patient was admitted routinely to the inpatient epilepsy monitoring unit (EMU) two days after her consultation. During her admission, seizure medications were stopped during EMU observation. She had a generalized tonic-clonic seizure episode followed by persistent tachycardia resulting in cardiac evaluation and intensive care unit monitoring. Due to cardiovascular concerns, Troponin I, transthoracic echocardiograph (TTE), and EKG were subsequently ordered. Her Troponin I was 533 ng/L with a reference normal value of <51.4 ng/L. The TTE demonstrated a dilated left ventricular cavity with wall thickness below normal limits. The patient had severe hypokinesis with an estimated ejection fraction between 5-10%. The subsequent EKG demonstrated a T wave abnormality and prolonged QT interval.

Conclusions Based on this unique case, we advocate for the incorporation of cardiac monitoring as part of a standardized protocol for patients undergoing EMU admissions to assist in the identification of potential cardiac events such as TTC and arrhythmias which can occur following seizures Additionally, we would like to highlight TTC as a risk during EMU admission, and a possible fatal complication.

Authors/Disclosures
Muhammad Hussain, MD (Virginia Tech Carilion Clinic) PRESENTER	Dr. Hussain has nothing to disclose.
Haseeb Goheer	Haseeb Goheer has nothing to disclose.
Soundarya Gowda, MD (HCA neurological Associates)	Dr. Gowda has nothing to disclose.
Aashit K. Shah, MD, FAAN (Carilion Clinic)	Dr. Shah has stock in Abbot, Abbivie, Gilead, Johnson and Johnson, Pfizer. The institution of Dr. Shah has received research support from Xenon Pharma.

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