Reverse Takotsubo Cardiomyopathy Complicated by Neurogenic Pulmonary Edema in Aneurysmal Subarachnoid Hemorrhage: A Case Report
Year: 2026
Type: article
Study design: Case Report
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.
Source: Cureus
Institutions: Hamad Medical Corporation, Deccan College of Medical Sciences
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7214675064