Takotsubo syndrome (TTS) is a transient transient
left ventricular dysfunction, predominantly affecting elderly women and often preceded by emotional or physical stress. TTS may be the cause as well as the consequence of
stroke. We report a 82-years old female with a history of long-standing untreated arterial
hypertension who was hospitalized because of a left-sided tongue
paralysis and
dysarthria. Cerebral magnetic resonance imaging showed ischemic lesions in the territory of the right middle cerebral artery affecting the capsula interna and gyrus praecentralis. The carotid and cerebral arteries showed extensive atherosclerotic wall irregularities, a high-grade
stenosis of the M1-segment of the right middle cerebral artery and a 60%
stenosis of the internal carotid artery at its origin. Elevated
creatine-kinase and Pro-
brain-natriuretic peptide levels and development of new ischemic signs in the electrocardiogram suggested
myocardial infarction, although the patient did not complain about cardiac symptoms. Echocardiography showed apical ballooning which resolved during the following days. The patient refused coronary angiography why the diagnosis of TTS was not completely established. However, normalization of echocardiogram and ECG were indicative for TTS. TTS has to be considered in
stroke patients, irrespective of their etiology. Since patients often do not report typical symptoms or may even be asymptomatic, TTS can be overlooked. If the ECG in
stroke patients shows signs of
myocardial ischemia,
troponin and BNP levels should be measured whose ratio may even help to differentiate between TTS and
myocardial infarction. Echocardiography, coronary angiography and follow-up investigations are needed to confirm the diagnosis of TTS.