Neurogenic stunned myocardium associated with acute spinal cord infarction: a case report.

Introduction. Neurogenic stunned myocardium (NSM) is a reversible cardiomyopathy resulting in transient left ventricular apical ballooning presumed to result from catecholamine surge occurring under physiologic stress. Acute spinal cord ischemia is a rare ischemic vascular lesion. We report a case of neurogenic stunned myocardium occurring in the setting of acute spinal cord infarction. Methods. Singe case report was used. Results. We present the case of a 63-year-old female with a history of prior lacunar stroke, hypertension, chronic back pain, and hypothyroidism who presented with a brief episode of diffuse abdominal and bilateral lower extremity pain which progressed within minutes to bilateral lower extremity flaccid paralysis. MRI of the spinal cord revealed central signal hyperintensity of T2-weighted imaging from conus to T8 region, concerning for acute spinal cord ischemia. Transthoracic echocardiogram was performed to determine if a cardiac embolic phenomenon may have precipitated this ischemic event and showed left ventricular apical hypokinesis and ballooning concerning for NSM. Conclusion. Neurogenic stunned myocardium is a reversible cardiomyopathy which has been described in patients with physiologic stress resulting in ventricular apical ballooning. Our case suggests that it is possible for neurogenic stunned myocardium to occur in the setting of acute spinal cord ischemia

Neurogenic Stunned Myocardium Associated with Acute Spinal Cord Infarction: A Case Report

Introduction. Neurogenic stunned myocardium (NSM) is a reversible cardiomyopathy resulting in transient left ventricular apical ballooning presumed to result from catecholamine surge occurring under physiologic stress. Acute spinal cord ischemia is a rare ischemic vascular lesion. We report a case of neurogenic stunned myocardium occurring in the setting of acute spinal cord infarction. Methods. Singe case report was used. Results. We present the case of a 63-year-old female with a history of prior lacunar stroke, hypertension, chronic back pain, and hypothyroidism who presented with a brief episode of diffuse abdominal and bilateral lower extremity pain which progressed within minutes to bilateral lower extremity flaccid paralysis. MRI of the spinal cord revealed central signal hyperintensity of T2-weighted imaging from conus to T8 region, concerning for acute spinal cord ischemia. Transthoracic echocardiogram was performed to determine if a cardiac embolic phenomenon may have precipitated this ischemic event and showed left ventricular apical hypokinesis and ballooning concerning for NSM. Conclusion. Neurogenic stunned myocardium is a reversible cardiomyopathy which has been described in patients with physiologic stress resulting in ventricular apical ballooning. Our case suggests that it is possible for neurogenic stunned myocardium to occur in the setting of acute spinal cord ischemia

Spontaneous subarachnoid hemorrhage and acute hydrocephalus in a patient with a Left Ventricular Assist Device (LVAD)

Background: Intracranial hemorrhages associated with new generation left ventricular assist devices (LVAD) are increasingly reported as the use of these life saving devices is becoming more common, but few data are currently available to guide the acute management of these critically ill patients. Methods: This is a case presentation of a 33-year-old woman status post LVAD implantation on therapeutic anticoagulation who developed acute headache followed by rapidly progressive impairment of consciousness secondary to spontaneous subarachnoid hemorrhage and hydrocephalus. Results: After discontinuation of heparin infusion, the patient underwent external ventricular drain placement(EVD)and her mental status fully recovered. Her work-up was negative for aneurysmal sources of bleeding. She received daily aspirin for 7 days for antiplatelet effect during which she did not experience any thromboembolic events related to the LVAD. At day 6 the EVD was clamped for 24 hours and her neurological exam remained intact. The EVD was removed and she was restarted on heparin infusion without further complications. Conclusions: Our experience suggests that in case of subarachnoid hemorrhage in patients with LVADs, temporary suspension of anticoagulation and EVD placement is safe and can lead to good neurological outcome

Metal ion and proton stabilization of turn motif in the synthetic octapeptide L-Histidyl-(Glycyl-L-Histidyl)3-Glycine

Protonation and metal ion co-ordination can induce alpha- and gamma-turns respectively, of the linear octapeptide His-(Gly-His)(3)-Gly (His = histidine, Gly = glycine) and in both cases the imidazole groups of appropriately positioned His residues have been shown to be essential in the stabilisation of the folded structure; divalent metal ions exhibit different folding inducing ability of the octapeptide with Ni2+ having the greatest ability at physiological pH