Review Stress cardiomyopathy (tako-tsubo) triggered by nervous system diseases: A systematic review of the reported cases ☆ Italo Porto a, ⁎, Roberta Della Bona a , Andrea Leo b , Riccardo Proietti c , Maurizio Pieroni a , Carlo Caltagirone d, e , Gianfranco Spalletta e , Leonardo Bolognese a , Luca Cravello e a Cardiovascular and Neurological Department, Ospedale San Donato, Arezzo, Italy b Department of Cardiovascular Medicine, Catholic University, Rome, Italy c Cardiology Department, Luigi Sacco Hospital, Milan, Italy d Department of Neuroscience - University of Tor Vergata, Rome, Italy e IRCCS Fondazione Santa Lucia, Rome, Italy abstract article info Article history: Received 18 September 2012 Received in revised form 19 December 2012 Accepted 18 January 2013 Available online xxxx Keywords: Tako-tsubo Stress cardiomyopathy Nervous system disease Background: It is not clarified whether the transient, regional left ventricular dysfunction (TRLVD) associated with several neurological disorders shares the same pathophysiology with the classical tako-tsubo cardiomy- opathy occurring without overt neurological disease, and whether it is appropriate to include these patients in a single stress cardiomyopathy (SCM) condition. Methods: In February 2012, we systematically explored major electronic medical information sources to iden- tify cases of TRLVD triggered by neurological disorders. Results: The 81 selected papers reported a total of 124 patients, suffering from neurological disorders, in whom TRLVD occurred: 117 with central nervous system diseases, 6 with peripheral nervous system diseases and 1 with both systems involved. Most patients were females (n = 102), mean age was 63 ± 15 years, and the majority presented with an apex-involving pattern. The most common disease described was subarachnoid hemorrhage (n = 52), followed by stroke/transient ischemic attack (n = 24), and seizures (n = 18). TRLVD in neurological patients was often associated with need of inotropic support, orotracheal intubation, cerebrovascular spasm and delayed surgery. Conclusions: TRLVD is a complication of neurological diseases, in particular in female patients in post-menopausal phase. The predilection for neurological damage at or close to the insular cortex highlights the pivotal role of sym- pathetic over-activation. Many other similarities with tako-tsubo support the inclusion in a single SCM category. © 2013 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Included by the International Society of Cardiology among cardio- myopathies [1], the stress cardiomyopathy (SCM), commonly named tako-tsubo, is primarily characterized by transient mid-segmental left ventricular (LV) dysfunction involving or not the apex, mimicking the shape of a trap used by Japanese fishermen to catch octopus (hence the name) [2]. SCM often occurs in combination with a stressful event, and associations with different triggers have been reported [3]. SCM generally carries a favorable short-term prognosis with full recovery of the LV function [4], yet serious complications may rarely arise. A strong preference for post-menopausal women is well known [5]. While the underlying pathophysiology of this condition is not fully clarified, the finding of an enhanced central and local sympathetic stimulation ap- pears to be consistent [6]. These characteristics have long puzzled researchers, which have recognized the many features shared by classical SCM with the “neurogenic stunned myocardium” (NSM), typically observed soon after subarachnoid hemorrhage (SAH) [7] or stroke [8], in particular when a transient, regional LV dysfunction (TRLVD) is present [9]. Indeed, a recent consensus document updating the Mayo Clinic guidelines has attenuated the distinction between the two conditions, to the effect of removing the SAH as an exclusion criterion for tako-tsubo diagnosis [2]. New denominations, including “neurogenic stressed myocardium”, have been proposed [10]. Our systematic review aims at gathering the scattered evidence of reported cases of TRLVD associated with speci fic neurological diseases, in order, firstly, to evaluate whether regional NSM and classical SCM are in fact the same syndrome, and secondly to extract insights on SCM pathogenesis. International Journal of Cardiology xxx (2013) xxx–xxx ☆ All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation. ⁎ Corresponding author at: Cardiovascular and Neurologic Department, Ospedale San Donato, Via Pietro Nenni 22, 52100, Arezzo, Italy. E-mail address: italo.porto@gmail.com (I. Porto). IJCA-15753; No of Pages 8 0167-5273/$ – see front matter © 2013 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ijcard.2013.01.031 Contents lists available at SciVerse ScienceDirect International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard Please cite this article as: Porto I, et al, Stress cardiomyopathy (tako-tsubo) triggered by nervous system diseases: A systematic review of the reported cases, Int J Cardiol (2013), http://dx.doi.org/10.1016/j.ijcard.2013.01.031