https://orcid.org/0000-0003-0800-798X
A 47-year-old woman with previous left occipital cavernoma excision 4 years prior and a right internal carotid artery aneurysm under surveillance presents with vivid hallucinations of being chased by men and taken as prisoner in Harry Potter’s Hogwarts Express to Azkaban prison.
Her clinical examination was unremarkable apart from a tongue ulcer (Panel A). Cerebrospinal fluid analysis showed no evidence of meningitis. Brain magnetic resonance imaging (MRI) showed bilateral temporal lobe and hippocampus T2 signal enhancement (Panel B, yellow arrows) suggestive of oedema from herpes encephalitis, which was treated with intravenous Acyclovir. Electrocardiogram revealed widespread deep T-wave inversion, with significant troponin rise (peak 850 ng/L, normal <14 ng/L) and NT-proBNP elevation (1304 ng/L, normal <400 ng/L), without cardiac symptoms.
Echocardiography showed dynamic contractility of basal left ventricular (LV) segments with severe apical hypokinesia and mildly impaired systolic function. Cardiac MRI showed elevated apical myocardial T1 (Panel C, black arrowheads) and T2 (Panel D) values with no late gadolinium enhancement, consistent with oedema from Takatsubo cardiomyopathy causing the wall motion abnormalities (Supplementary material online, Video S1), rather than a myocardial infarction. She was discharged following significant improvement, with multi-specialty follow-up and interval imaging.
Takotsubo cardiomyopathy or ‘broken heart’ syndrome following encephalitis is rare. Takatsubo cardiomyopathy was thought to be due to sympathetic autonomic surge from the vivid Harry Potter themed hallucinations, resulting in neurocardiogenic phenomenon due to temporal lobe encephalitis. MRI of the brain and the heart provided vital information towards diagnosis and appropriate treatment.
Supplementary material is available at European Heart Journal online.
Funding: the authors report no specific funding related to this article.
Conflict of interest: The authors have submitted their declaration which can be found in the article Supplementary Material online.
