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CC BY 4.0 · J Neuroanaesth Crit Care
DOI: 10.1055/s-0045-1809056
Case Report

Neurogenic Stunned Myocardium Progressing to Takotsubo Cardiomyopathy with Milrinone

Siddharth Srinivasan
1   Department of Neurosurgery, Fortis Hospital, New Delhi, India
,
Arjun Balakrishnan 
2   Department of Anesthesiology, Kasturba Medical College - Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
,
Rajesh P. Nair
3   Department of Neurosurgery, Adarsha Hospitals, Udupi, Karnataka, India
,
Girish Menon
4   Department of Neurosurgery, Kasturba Medical College - Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Abstract

A 67-year-old female came with acute-onset headache and altered sensorium secondary to a ruptured right giant supraclinoid internal carotid artery aneurysm. Echocardiography revealed global wall motion abnormalities. She underwent aneurysm clipping on day 4 following ictus and her postoperative Glasgow Coma Scale (GCS) score was E2VTM5. She developed an infarct in the caudate nucleus for which milrinone infusion was started. Following milrinone infusion her blood pressure dropped significantly. Despite stopping milrinone, it did not respond to noradrenaline or dopamine. Investigations revealed a troponin of 0.6 ng/mL, and electrocardiogram showed new ST-T changes in leads V3-V6. Echocardiography showed paradoxical apical excursion, suggestive of Takotsubo cardiomyopathy. She was started on vasopressin, her blood pressure stabilized, and noradrenaline was gradually tapered. Due to prolonged hypoperfusion, however, GCS dropped to E2VTM3. Eventually, inotropes were stopped, and cardiac contractility recovered. The patient had a sudden drop in GCS on postoperative day 25 and died.

Keywords

neurogenic stunned myocardium - Takotsubo cardiomyopathy - milrinone


Publication History

Article published online:
12 May 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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