Abstract

Introduction: Takotsubo cardiomyopathy is known to be a cardiac dysfunction associated with neurological disorders. While it often occurs as a complication following a stroke or head injury, it rarely develops as a result of spinal cord disorders. The author has encountered a patient accompanied with takotsubo cardiomyopathy following surgical treatment for a spinal epidural hematoma from lower cervical to upper thoracic level. Case: A 75-year-old woman was admitted by the emergency medical service presenting with sudden weakness in both lower limbs. Patient was found to have motor and sensory deficit below forth thoracic (Th4) level. Following magnetic resonance imaging (MRI) check, patient was diagnosed with an epidural hematoma of the spinal cord at the sixth cervical (C6) to seventh thoracic (Th7) level. Patient subsequently underwent emergency epidural hematoma evacuation and laminectomy. On the fifth day following surgery, patient developed secondary takotsubo cardiomyopathy. Her cardiac dysfunction improved with conservative medical treatment involving fluid volume replacement with anticoagulant infusion. Discussion: It was believed that an epidural hematoma of the spinal cord extending from the lower cervical spine to the upper thoracic spine suppressed sympathetic nerve activity. Then, operative decompression of spinal cord leaded to the development of takotsubo cardiomyopathy. It was thought that rapid adrenergic nerve activity fluctuations resulting from the functional recovery from a dysfunction of the sympathetic nervous system were the cause of cardiac dysfunction.