Epileptic seizures complicated by Takotsubo syndrome

Takotsubo syndrome is a disorder characterised by a reversible ventricular dysfunction, angina-like precordial pain and electromyographic changes with no evidence of coronary obstruction in examinations performed by coronary catheterisation. It is triggered by stress and is frequent following bouts of epileptic seizures. We report the case of a patient who began with this cardiomyopathy following epileptic seizures suffered after one of her haemodialysis sessions. We report the case of a 55-year-old female on haemodialysis due to chronic renal failure, with epilepsy secondary to a residual lesion in the right frontoparietal area due to a haematoma that required surgical evacuation. After her haemodialysis session she suffered an attack of focal epilepsy with secondary generalisation and, some hours later, pain in the middle of her chest. Serial enzymes revealed increased levels of troponin I and, electrocardiographically, negative T waves were observed in precordial derivations (V2-V6). Coronary catheterisation was performed, with normal results, and alterations were noted in contractility, which were confirmed as being transient in a serial echocardiography study. All the previous data lead us to a suspected diagnosis of Takotsubo syndrome. Cardiac complications are one of the causes of morbidity and mortality in epilepsy, and Takotsubo syndrome is an example of them. The real incidence of this syndrome is unknown, but given its involvement in mortality caused by heart problems in epilepsy it is important to suspect it in the presence of cardiac dysfunction following epileptic seizures.