• Pirbhat Shams Section of Cardiology, Department of Medicine, The Aga Khan University, Karachi-Pakistan
  • Intisar Ahmed Section of Cardiology, Department of Medicine, The Aga Khan University, Karachi-Pakistan
  • Aamir Hameed Khan Section of Cardiology, Department of Medicine, The Aga Khan University, Karachi-Pakistan


Takotsubo, Reverse Takotsubo, Stress cardiomyopathy, Meningoencephalitis, Cardiomyopathy, dilated cardiomyopathy


Reverse Takotsubo cardiomyopathy is a rare variant of stress cardiomyopathy. A 22-year-old male presented with altered mentation and fever. He was intubated due to low Glasgow Coma Scale. CT head plain showed diffuse cerebral oedema. Patient had raised troponin-I and echocardiogram revealed reduced ejection fraction with hyperdynamic apical segments and akinetic basal to mid segments suggestive of reverse Takotsubo cardiomyopathy (rTCM). Association of rTCM with neuropsychiatric disorders such as intracranial/epidural haemorrhages and anorexia nervosa has been defined. However, it is rare to have rTCM with meningoencephalitis.


Sato H, Tateishi H, Uchida T, Dote K, Ishihara M, Kodama K, et al. Clinical aspect of myocardial injury: from ischemia to heart failure. Kagaku Hyoronsha 1990:55–64.

Ramaraj R, Movahed MR. Reverse or Inverted Takotsubo Cardiomyopathy (Reverse Left Ventricular Apical Ballooning Syndrome) Presents at a Younger Age Compared With the Mid or Apical Variant and Is Always Associated With Triggering Stress. Congest Heart Fail 2010;16(6):284–6.

Sanchez K, Glener S, Esplin NE, Okorie ON, Parikh A. A Case of Reverse Takotsubo Cardiomyopathy Incited by a Spinal Subdural Hematoma. Case Rep Neurol Med 2019;2019:9285460.

Beppu H YY, Katsuki T, Hinoshita F. Reverse Takotsubo Cardiomyopathy and Shock Supported by Continuous Hemodiafiltration in a Patient with Anorexia Nervosa. Med Case Rep 2017;3(2):13.

London F, Gonzalez Rodriguez de Azero N, Philippart M, Higny J, Mulquin N. Reverse takotsubo cardiomyopathy triggered by a multiple sclerosis relapse. Acta Neurol Belg 2019;119(2):295–7.

Ghadri JR, Cammann VL, Templin C. The International Takotsubo Registry: Rationale, Design, Objectives, and First Results. Heart Fail Clin 2016;12(4):597–603.

Tagami T, Mertens A, Rothschild D, Chowdhury P. A case of reverse takotsubo cardiomyopathy caused by an eating disorder. J Cardiol Cases 2017;15(3):77–9.

Lee CH, Son JW, Kim U. Reverse Takotsubo Cardiomyopathy following Inadvertent Intrathecal Injection during Percutaneous Epidural Neuroplasty. Heart Lung Circ 2015;24(9):e148–51.

Chehab O, Ioannou A, Sawhney A, Rice A, Dubrey S. Reverse Takotsubo Cardiomyopathy and Cardiogenic Shock Associated With Methamphetamine Consumption. J Emerg Med 2017;53(5):e81–3.

Gobeske KT, Sarano ME, Fugate JE, Wijdicks EF. Medulla Oblongata Hemorrhage and Reverse Takotsubo Cardiomyopathy. Neurocrit Care 2018;29(3):508–11.

Piérard S, Vinetti M, Hantson P. Inverted (Reverse) Takotsubo Cardiomyopathy following Cerebellar Hemorrhage. Case Rep Cardiol 2014;2014:781926.

Abusnina W, Ratajczak T, Elayi S, Darrat Y. Reverse takotsubo cardiomyopathy following catheter ablation of atrial fibrillation. J Am Call Cardiol 2020;75(11 Suppl 1):3129.

Kaoukis A, Panagopoulou V, Mojibian HR, Jacoby D. Reverse Takotsubo Cardiomyopathy Associated With the Consumption of an Energy Drink. Circulation 2012;125(12):1584–5.

Samuels MA. The Brain-Heart Connection. Circulation 2007;116(1):77–84.

Nef HM, Möllmann H, Kostin S, Troidl C, Voss S, Weber M, et al. Tako-Tsubo cardiomyopathy: intraindividual structural analysis in the acute phase and after functional recovery. Eur Heart J 2007;28(20):2456–64.

Gianni M, Dentali F, Grandi AM, Sumner G, Hiralal R, Lonn E. Apical ballooning syndrome or takotsubo cardiomyopathy: a systematic review. Eur Heart J 2006;27(13):1523–9.

Barbaryan A, Bailuc SL, Patel K, Raqeem MW, Thakur A, Mirrakhimov AE. An Emotional Stress as a Trigger for Reverse Takotsubo Cardiomyopathy: A Case Report and Literature Review. Am J Case Rep 2016;17:137–42.

Ghadri JR, Cammann VL, Napp LC, Jurisic S, Diekmann J, Bataiosu DR, et al. Differences in the Clinical Profile and Outcomes of Typical and Atypical Takotsubo Syndrome: Data From the International Takotsubo Registry. JAMA Cardiol 2016;1(3):335–40.

Elikowski W, Małek-Elikowska M, Kudliński B, Skrzywanek P, Smól S, Rzymski S. ECG pattern in reverse takotsubo cardiomyopathy demonstrated in 5 cases with intracranial hemorrhage. Pol Merkur Lekarski 2016;41(243):136–40.

Kumai T, Inamasu J, Watanabe E, Sugimoto K, Hirose Y. Differences between Takotsubo cardiomyopathy and reverse Takotsubo cardiomyopathy associated with subarachnoid hemorrhage. Int J Cardiol Heart vasc 2016;11:99–103.

Awad HH, McNeal AR, Goyal H. Reverse Takotsubo cardiomyopathy: a comprehensive review. Ann Transl Med 2018;6(23):460.

Laghari AH, Khan AH, Kazmi KA. Takotsubo cardiomyopathy: ten year experience at a tertiary care hospital in Pakistan. BMC Res Notes 2014;7:932.