Coexisting subarachnoid hemorrhage and subdural hematoma mimicking acute anterolateral myocardial infarction

Area of Science:

• Neurology
• Cardiology
• Pathophysiology

Background:

• Central nervous system (CNS) events, including subarachnoid hemorrhage (SAH), subdural hematoma, and ischemic stroke, are associated with cardiac complications.
• These cardiac manifestations can include ischemic electrocardiographic changes, elevated cardiac biomarkers (troponin, creatine kinase-MB), and regional wall motion abnormalities.
• The underlying pathophysiology is not fully understood, with neurocardiogenic injury potentially induced by catecholamines suggested as a contributing factor.

Observation:

• This report details a case involving coexisting subarachnoid hemorrhage and subdural hematoma.
• The patient presented with ischemic electrocardiographic changes, increased cardiac-specific enzymes, and a regional wall motion abnormality.
• Importantly, coronary angiography revealed normal epicardial coronary arteries, ruling out obstructive coronary artery disease.

Findings:

• The observed cardiac dysfunction in the context of intracranial hemorrhage, despite normal coronary arteries, supports the concept of neurogenic stunned myocardium.
• Elevated cardiac markers and ECG changes following CNS events can mimic acute coronary syndromes.
• This highlights the potential for a direct link between neurological injury and myocardial damage.

Implications:

• Accurate differentiation between neurogenic stunned myocardium and myocardial dysfunction due to coronary artery disease is critical in patients with intracranial hemorrhages.
• Misdiagnosis can lead to inappropriate treatment strategies, potentially delaying or altering necessary neurocritical care.
• Understanding this association can improve diagnostic accuracy and guide tailored management approaches for these complex cases.