Takotsubo Syndrome: A Case of Acute Altered Mental Status, Aphasia, and Weakness

Background: Stress-induced cardiomyopathy (SICM), also known as Takotsubo syndrome, can mimic acute coronary syndrome despite the absence of obstructive coronary artery disease. This case report explores the diagnostic workup and management of a patient with potential SICM presenting with sudden onset altered mental status, aphasia, and weakness. Case: A 46-year-old woman with no past medical history presented with acute altered mental status, aphasia, and weakness requiring intubation. Blood glucose level was 123 mg/dL. Initial workup for stroke was negative. Extensive neurological workup, including cranial imaging and electroencephalography, revealed no abnormalities. Initial ECG was unremarkable, but elevated troponin levels and a reduced left ventricular ejection fraction (LVEF) of 40% on echocardiogram suggested probable cardiac involvement. Subsequent coronary angiography demonstrated normal coronary arteries. Repeat echocardiogram showed improvement in LVEF to 45-50%. The patient remained hemodynamically stable throughout hospitalization. Stress-induced cardiomyopathy was suspected as the underlying cause of her presentation due to her family and social history. The patient was discharged home on a regimen of metoprolol, valsartan, and aspirin with close follow-up with cardiology and primary care physician. Conclusion: This case highlights a possible atypical presentation of SICM with neurological symptoms and the importance of considering it in the differential diagnosis of patients with unexplained altered mental status and elevated cardiac biomarkers, even in the absence of abnormal ECG findings. Keyword: aphasia; stress; cardiomyopathy; altered mental status; stress-induced cardiomyopathy; Takotsubo syndrome; encephalopathy.