2026 Clinician Corner - Neurogenic shock to the heart: a rare case of meningitis-triggered reverse takotsubo cardiomyopathy

Abstract 

Reverse takotsubo cardiomyopathy, a rare variant of stress-induced cardiomyopathy, is characterized by basal hypokinesis with apical sparing and can be associated with neurological insults. Prompt recognition is essential to avoid unnecessary invasive interventions and to guide appropriate supportive care. Here, we report a case of reverse takotsubo cardiomyopathy triggered by bacterial meningitis in a patient with a history of stroke and seizure disorder who presented with altered mental status, elevated cardiac biomarkers, and evolving electrocardiographic changes.  

Keywords:  Echocardiography; neurogenic stress cardiomyopathy; stress-induced cardiomyopathy

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Faculty credentials/disclosure 

The planners and faculty for this activity have no relevant financial relationships to disclose. The authors report no funding. The patient consented to publication of this case report. 

Process

Click the "add to cart/begin" button, pay any relevant fee, take the quiz, complete the evaluation, and claim your CME credit.  You must achieve 100% on the quiz with unlimited attempts available.

  • By completing this process, you are attesting that you have read the journal article.

Expiration date:

Credit eligibility for this article is set to expire on July 1, 2027.

Learning Objectives

After completing the article, the learner should be able to:

  • Recognize the association between acute neurological insults, such as bacterial meningitis, and the development of reverse takotsubo cardiomyopathy (rTTC). 

  • Implement appropriate diagnostic and supportive management strategies for patients presenting with concurrent neurological and cardiac dysfunction to optimize recovery and prevent unnecessary invasive procedures. 

  • Explain the proposed neurocardiac mechanisms underlying stress-induced cardiomyopathy, including catecholamine-mediated myocardial stunning secondary to sympathetic overactivation. 

  • Differentiate reverse takotsubo cardiomyopathy from acute coronary syndromes using clinical presentation, electrocardiogram, and echocardiographic findings, particularly the pattern of basal hypokinesis with apical sparing. 

Key Points 

  • Severe lactic acidosis with refractory hypoglycemia may represent a paraneoplastic metabolic syndrome, particularly in aggressive hematologic malignancies. 

  • Failure of lactate levels to improve with standard resuscitation should prompt early oncologic evaluation, as delayed recognition of malignancy-associated type B lactic acidosis is associated with high mortality.  

  • Hyper-Warburgism is an extreme manifestation of the Warburg effect, characterized by uncontrolled aerobic glycolysis leading to persistent lactate overproduction and rapid glucose consumption despite adequate oxygenation and dextrose supplementation.  

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Course summary
Available credit: 
  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2

    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.00 MOC points in the American Board of Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

  • 1.00 American Board of Surgery (ABS) Accredited CME

    Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.

     

     

  • 1.00 AMA PRA Category 1 Credit™
    The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
  • 1.00 Attendance
Course opens: 
07/01/2026
Course expires: 
07/01/2027
Cost:
$25.00

Ma’in Abumuhfouz, MD1, Rebecca Adler, DO1, David Gonzalez Sanchez, MD1, Saeed Suleiman, MD1, and Kyle Lehenbauer, MD2 

 

1 University of Missouri - Kansas City, Kansas City, Missouri, USA 

2 Saint Luke’s Hospital of Kansas City, Kansas City, Missouri, USA 

 

Corresponding author:  Ma’in Abumuhfouz, MD, Department of Internal Medicine, University of Missouri – Kansas City, 2411 Holmes St., Kansas City, MO 64108 (e-mail: [email protected]) 

Accreditation

The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation

AMA PRA Category 1 Credit™

The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABS CC

Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.

ABIM MOC

 Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

Available Credit

  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2

    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.00 MOC points in the American Board of Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

  • 1.00 American Board of Surgery (ABS) Accredited CME

    Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.

     

     

  • 1.00 AMA PRA Category 1 Credit™
    The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
  • 1.00 Attendance

Price

Cost:
$25.00
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