Reverse Takotsubo Cardiomyopathy Complicated by Neurogenic Pulmonary Edema in Aneurysmal Subarachnoid Hemorrhage: A Case Report.
4 affiliations
- 1Department of Surgical Intensive Care, Hamad Medical Corporation, Doha, QAT.
- 2Department of Cardiology and Cardiovascular Surgery, Heart Hospital, Hamad Medical Corporation, Doha, QAT.
- 3Department of Anesthesiology, Hamad Medical Corporation, Doha, QAT.
- 4Department of Medicine, Deccan College of Medical Sciences, Hyderabad, IND.
Abstract
Takotsubo cardiomyopathy (TTC) is a recognized and potentially severe cardiac complication in patients with aneurysmal subarachnoid hemorrhage (aSAH). Reverse TTC (rTTC), a rare variant characterized by basal hypokinesis with apical sparing, is infrequently reported in this setting. The coexistence of rTTC with neurogenic pulmonary edema has not been previously described and represents a complex neurocardiac interaction that can significantly worsen outcomes. We report the case of a previously healthy 30-year-old man who presented with high-grade aSAH secondary to rupture of an anterior communicating artery aneurysm. His course was complicated by neurogenic pulmonary edema, refractory hypoxemia, hemodynamic instability, and rTTC. Management required early airway protection, bronchoscopy, vasopressor support, and complex stent-assisted endovascular coiling. Echocardiography demonstrated reduced left ventricular ejection fraction with basal hypokinesis and apical sparing, consistent with rTTC. Careful hemodynamic management was essential to balance cerebral perfusion against myocardial dysfunction. With multidisciplinary critical care and structured rehabilitation, the patient achieved favorable neurological and functional recovery. This case highlights that rTTC in aSAH is not a benign condition and may be associated with increased morbidity when combined with neurogenic pulmonary edema due to massive catecholamine surge. Early recognition using bedside echocardiography, prompt aneurysm securing, and balanced hemodynamic support are critical for improving outcomes.
Related
- Do Early Prognostic Measures Differentiate Mechanisms of ICU Death in Aneurysmal Subarachnoid Hemorrhage? An Analysis of Fatal Outcomes
- Non-aneurysmal perimesencephalic subarachnoid hemorrhage in a middle-aged female possibly triggered by Valsalva-like event and uncontrolled hypertension: a case report
- Interventional Rescue Therapy for Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage: 10-Year Experience
- Suspected neurogenic pulmonary edema after subarachnoid hemorrhage: a brain–heart–lung diagnostic challenge
- Safety of Adult-dose Clazosentan in an Adolescent with Aneurysmal Subarachnoid Hemorrhage: A Case Report
BibTeX
@article{nainthramveetil2026reverse,
title = {{Reverse Takotsubo Cardiomyopathy Complicated by Neurogenic Pulmonary Edema in Aneurysmal Subarachnoid Hemorrhage: A Case Report.}},
author = {Mohammed Mansoor Nainthramveetil and Ahmed Elyas and Shajahan Idayathulla and Umme Nashrah and Nissar Shaikh},
journal = {Cureus},
year = {2026},
month = sep,
doi = {10.7759/cureus.117068},
url = {https://europepmc.org/article/MED/42953261},
note = {CC BY},
}
RIS
TY - JOUR
TI - Reverse Takotsubo Cardiomyopathy Complicated by Neurogenic Pulmonary Edema in Aneurysmal Subarachnoid Hemorrhage: A Case Report.
AU - Mohammed Mansoor Nainthramveetil
AU - Ahmed Elyas
AU - Shajahan Idayathulla
AU - Umme Nashrah
AU - Nissar Shaikh
PY - 2026
DA - 2026/09/28
JO - Cureus
DO - 10.7759/cureus.117068
UR - https://europepmc.org/article/MED/42953261
AB - Takotsubo cardiomyopathy (TTC) is a recognized and potentially severe cardiac complication in patients with aneurysmal subarachnoid hemorrhage (aSAH). Reverse TTC (rTTC), a rare variant characterized by basal hypokinesis with apical sparing, is infrequently reported in this setting. The coexistence of rTTC with neurogenic pulmonary edema has not been previously described and represents a complex neurocardiac interaction that can significantly worsen outcomes. We report the case of a previously healthy 30-year-old man who presented with high-grade aSAH secondary to rupture of an anterior communicating artery aneurysm. His course was complicated by neurogenic pulmonary edema, refractory hypoxemia, hemodynamic instability, and rTTC. Management required early airway protection, bronchoscopy, vasopressor support, and complex stent-assisted endovascular coiling. Echocardiography demonstrated reduced left ventricular ejection fraction with basal hypokinesis and apical sparing, consistent with rTTC. Careful hemodynamic management was essential to balance cerebral perfusion against myocardial dysfunction. With multidisciplinary critical care and structured rehabilitation, the patient achieved favorable neurological and functional recovery. This case highlights that rTTC in aSAH is not a benign condition and may be associated with increased morbidity when combined with neurogenic pulmonary edema due to massive catecholamine surge. Early recognition using bedside echocardiography, prompt aneurysm securing, and balanced hemodynamic support are critical for improving outcomes.
SN - 2168-8184
ER -