%0 Journal Article
%T Anesthesia-induced Takotsubo cardiomyopathy in trigeminal neuralgia: illustrative case.
%A Mazzaglia G
%A Bonomo G
%A Rubiu E
%A Murabito P
%A Amato A
%A Ferroli P
%A Gemma M
%J J Neurosurg Case Lessons
%V 5
%N 1
%D Jan 2023 2
%M 36593670
暂无%R 10.3171/CASE22424
%X <B>BACKGROUND: </B>Takotsubo syndrome (TS) represents a form of nonischemic cardiomyopathy characterized by sudden and temporary weakening of the myocardium. Many data suggest a primary role for sympathetic overstimulation in its pathogenesis. Nevertheless, these correlates are less easily identified during anesthesia.<BR><B>METHODS: </B>A 50-year-old female patient with a 4-year history of drug-resistant left trigeminal neuralgia. She was scheduled for surgical microvascular decompression. In the operating room, after induction of general anesthesia and oral intubation, the electrocardiogram revealed a significant ST segment elevation along with a sudden decrease in systolic blood pressure and heart rate. Administration of atropine caused a conversion into ventricular tachycardia. The advanced cardiac life support protocols were applied with prompt defibrillation and rapid recovery at sinus rhythm. A transthoracic echocardiogram revealed apical akinesia with ballooning of the left ventricle with a reduction of systolic function. An emergency coronary arteriography was performed, showing normal epicardial coronary vessels. After 4 days, echocardiography revealed normalization of the left ventricular function with improvement of the ejection fraction.<BR><B>CONCLUSIONS: </B>In patients affected by trigeminal neuralgia, chronic pain can lead to a state of adrenergic hyperactivation, which can promote TS during the induction of general anesthesia, probably through the trigeminocardiac reflex.