An 81-year-old right hand dominant Caucasian woman of Scandinavian ancestry was brought to the emergency department after witnessed to have lost consciousness followed by body shaking and unresponsiveness. This was preceded by the emotionally taxing news that a family member was in a severe life-threatening accident. Neurological examination was notable for disorientation, left gaze preference with left hemi body weakness and antigravity movements on the right hemi body. CT head and CT angiogram of head/neck showed no abnormality. MR brain with perfusion imaging demonstrated restricted diffusion with T2 hyperintensity in the right mesial thalamic region and hypoperfusion of the right cerebral hemisphere. Encephalogram showed multiple electrographic seizures involving the right cerebral hemisphere as well as bilateral independent periodic discharges with significant prominence on the right. The rest of the pertinent workup was negative. Prior history was devoid of identifiable seizure risk factors. Transthoracic echocardiogram (TTE) performed on the day of admission was notable for moderately reduced ejection fraction and diffuse hypokinesis. TTE eight months prior was normal. Given TTE changes in the setting of severe emotional distress, the patient was diagnosed with Takotsubo cardiomyopathy. The patient returned to neurologic baseline with symptomatic treatment 5 days after presentation. Repeat MR Brain showed resolution of thalamic hyperintensity.

We present the first documented case (to the best of our knowledge) of an acute symptomatic seizure resulting from transient cerebral hypoperfusion due to Takotsubo cardiomyopathy. Our findings serve as a reminder to clinicians to avoid biases toward psychogenic non-epileptic seizures when patients exhibit altered mentation following stressful events.