{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T05:37:17Z","timestamp":1769751437672,"version":"3.49.0"},"reference-count":11,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2021,10,28]],"date-time":"2021-10-28T00:00:00Z","timestamp":1635379200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Neurogenic pulmonary oedema (NPO) and Takotsubo cardiomyopathy are rare complications of ischaemic stroke. They are considered to be due to an excess catecholamine release after sympathetic nervous stimulation following stroke onset. Among the different types of Takotsubo cardiomyopathy, apical ballooning is recognized as the typical form, but three atypical patterns have been described (midventricular, basal, and focal) which are more commonly observed in patients with neurological disorders.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>A 78-year-old woman was treated with intravenous alteplase and underwent mechanical thrombectomy for ischaemic stroke. During the procedure, her respiratory condition quickly worsened requiring invasive mechanical ventilation because of a wide and persistent reduction of the inspiratory oxygen fraction\/arterial partial oxygen pressure ratio. Transthoracic echocardiography revealed moderate left ventricular systolic dysfunction with akinesis of the septal-apical and inferior-apical segments. Coronary angiography excluded obstructive lesions and\/or evidence of acute plaque rupture. Ventriculography confirmed akinesis\/dyskinesis of the inferior segment of the left ventricular apex associated with normal kinesis of the remaining segments. Chest X-ray revealed an infiltrative shadow on both lungs. After 24\u2009h from NPO onset, her respiratory function improved and she was finally discharged on Day 7 without neurological defects. Left ventricular systolic dysfunction was reversible and ejection fraction normalized in 3\u2009months.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>It is a very rare case of simultaneous NPO and Takotsubo cardiomyopathy following ischaemic stroke. Moreover, it is unique in that it is the first observation of NPO associated with an atypical pattern of Takotsubo cardiomyopathy, which is more frequent in patients with neurological disorders. A rapid recognition and treatment are essential for patient survival.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytab425","type":"journal-article","created":{"date-parts":[[2021,10,31]],"date-time":"2021-10-31T13:18:27Z","timestamp":1635686307000},"source":"Crossref","is-referenced-by-count":2,"title":["Combined neurogenic pulmonary oedema and atypical Takotsubo cardiomyopathy in a patient with ischaemic stroke: a unique case report"],"prefix":"10.1093","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4816-6187","authenticated-orcid":false,"given":"Letizia","family":"Riva","sequence":"first","affiliation":[{"name":"Cardiology Department, Maggiore Hospital, Bologna 40133, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0701-7329","authenticated-orcid":false,"given":"Gianni","family":"Casella","sequence":"additional","affiliation":[{"name":"Cardiology Department, Maggiore Hospital, Bologna 40133, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5238-4865","authenticated-orcid":false,"given":"Luigi","family":"Simonetti","sequence":"additional","affiliation":[{"name":"Neuroradiology Department, Maggiore Hospital, Bologna 40133, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1486-4507","authenticated-orcid":false,"given":"Andrea","family":"Zini","sequence":"additional","affiliation":[{"name":"IRCCS Istituto di Scienze Neurologiche di Bologna, Neurology Department & Stroke Center, Maggiore Hospital, Bologna 40133, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,10,28]]},"reference":[{"key":"2021120107441966400_ytab425-B1","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1111\/j.1399-6576.2007.01276.x","article-title":"Neurogenic pulmonary edema","volume":"51","author":"Baumann","year":"2007","journal-title":"Acta Anaesthesiol Scand"},{"key":"2021120107441966400_ytab425-B2","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1097\/ANA.0b013e3181778156","article-title":"Neurogenic pulmonary edema in patients with subarachnoid hemorrhage","volume":"20","author":"Muroi","year":"2008","journal-title":"J Neurosurg Anesthesiol"},{"key":"2021120107441966400_ytab425-B3","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1161\/CIRCRESAHA.117.311170","article-title":"Brain-heart interaction: cardiac complications after stroke","volume":"121","author":"Chen","year":"2017","journal-title":"Circ Res"},{"key":"2021120107441966400_ytab425-B4","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1016\/j.jcmg.2010.01.009","article-title":"Takotsubo cardiomyopathy: a unique cardiomyopathy with variable ventricular morphology","volume":"3","author":"Hurst","year":"2010","journal-title":"JACC Cardiovasc Imaging"},{"key":"2021120107441966400_ytab425-B5","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1001\/jamacardio.2016.0225","article-title":"Differences in the clinical profile and outcomes of typical and atypical Takotsubo syndrome: data from the International Takotsubo Registry","volume":"1","author":"Ghadri","year":"2016","journal-title":"JAMA Cardiol"},{"key":"2021120107441966400_ytab425-B6","first-page":"265","article-title":"Heart-brain interactions","volume":"20","author":"Riva","year":"2019","journal-title":"G Ital Cardiol"},{"key":"2021120107441966400_ytab425-B7","first-page":"21","article-title":"Takotsubo cardiomyopathy and neurogenic pulmonary edema following fibrinolytic therapy for embolic stroke: a case report","volume":"46","author":"Kitagawa","year":"2018","journal-title":"No Shinkei Geka"},{"key":"2021120107441966400_ytab425-B8","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.wneu.2018.12.206","article-title":"Takotsubo cardiomyopathy and neurogenic pulmonary edema after carotid endarterectomy","volume":"124","author":"Kitagawa","year":"2019","journal-title":"World Neurosurg"},{"key":"2021120107441966400_ytab425-B9","doi-asserted-by":"crossref","first-page":"1727","DOI":"10.1212\/WNL.42.9.1727","article-title":"Cardiovascular effects of human insula cortex stimulation","volume":"42","author":"Oppenheimer","year":"1992","journal-title":"Neurology"},{"key":"2021120107441966400_ytab425-B10","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1097\/ANA.0000000000000414","article-title":"A pediatric case with Takotsubo cardiomyopathy and neurogenic pulmonary edema due to an epidural hemorrhage","volume":"30","author":"Nakamori","year":"2018","journal-title":"J Neurosurg Anesthesiol"},{"key":"2021120107441966400_ytab425-B11","doi-asserted-by":"crossref","first-page":"2129","DOI":"10.1253\/circj.CJ-14-0859","article-title":"Diagnosis of Takotsubo cardiomyopathy","volume":"78","author":"Scantlebury","year":"2014","journal-title":"Circ J"}],"container-title":["European Heart Journal - 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