The Deceptive Presentation of Myocardial Stunning: A Case of Suspected Stroke Preceding In-Hospital Cardiac Arrest

Myocardial stunning is a reversible form of cardiac dysfunction that can follow cardiac arrest. We report a case where its presentation was masked by a primary neurological complaint. A 67-year-old male with cardiovascular risk factors presented to the emergency department with acute profound confusion and amnesia, initially suspected to be an acute ischemic stroke. Within one hour, his condition deteriorated, and he suffered an in-hospital cardiac arrest due to pulseless ventricular tachycardia, requiring prolonged resuscitation. Post-return of spontaneous circulation, comprehensive neuroimaging, including CT angiography and MRI, conclusively ruled out an acute cerebrovascular event. The working diagnosis was revised to a stroke mimic of undetermined etiology. Workup revealed severe left ventricular dysfunction consistent with global myocardial stunning. The patient's cardiac function and mental status gradually recovered with supportive care. This case highlights that acute, primary cardiac pathology can manifest with dramatic neurological symptoms, leading to initial misdiagnosis. It underscores the importance of considering myocardial stunning in any patient with neurological symptoms and cardiovascular instability, as rapid deterioration can occur.