Takotsubo Cardiomyopathy Following Insular Stroke in the M2 Area of the Left Middle Cerebral Artery

Takotsubo cardiomyopathy (TCM) is characterized as left ventricular apical ballooning in the absence of coronary occlusion. The most common trigger for TCM is emotional stress, but more cases are being reported demonstrating the association of TCM with intracranial pathologies. The pathophysiology of TCM is poorly understood but may be related to a surge of catecholamines, multivessel myocardial spasms, or neurologically mediated myocardial stunning. This case study describes the development of TCM after an ischemic stroke and establishes a possible association between the region of stroke and the development of TCM. We present the case of a 75-year-old woman who suffered a stroke of the left insular part (M2) of the middle cerebral artery (MCA) and subsequently experienced cardiac arrest with pulseless electrical activity and echocardiogram findings concerning for TCM within 24 hours. TCM should be recognized as a potential risk in the initial hours following a cerebral ischemic stroke, particularly when the insular region is affected. Prompt diagnosis and proper management of post-stroke TCM are essential for every patient presenting with new-onset cardiac dysfunction in stroke centers.