PMC10188972_01
Cerebral magnetic resonance imaging (T2-flair) performed at day one showing three demyelinating in the brainstem.
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F1
Cerebral MRI revealed multiple demyelinating lesions, three of which were located in the brainstem (Figure 1: Cerebral magnetic resonance imaging (T2-flair) performed at day one showing three demyelinating in the brainstem).
Electrocardiogram performed at day 1 revealing ST-segment depression in the inferior (II-III-aVF) and precordial (V3 through V6) leads.
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F2
An ECG showed ST-segment depression in the inferior (II-III-aVF) and precordial (V3 through V6) leads (Figure 2: Electrocardiogram performed at day 1 revealing ST-segment depression in the inferior (II-III-aVF) and precordial (V3 through V6) leads).
Transthoracic echocardiography performed at day one, showing a severely reduced left ventricular ejection fraction (24%) with basal and midventricular segments akinesia, and preserved apical contraction. There was no significant valvulopathy and right ventricular function was normal. A: Diastole, B: Systole.
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TTS, with basal and mid-ventricular segments akinesia and a spared apical contractility (Figure 3: Transthoracic echocardiography performed at day one, showing a severely reduced left ventricular ejection fraction (24%) with basal and midventricular segments akinesia, and preserved apical contraction. There was no significant valvulopathy and right ventricular function was normal.
Cardiac MRI images from T2-mapping revealing myocardial oedema in four, three and two-chamber views.
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Horizontal long-axis, color-coded images from T2-mapping revealed hyperintensity in the basal and mid-ventricular segments of the left ventricle that confirmed the presence of regional circumferential myocardial oedema (Figure 4: cardiac MRI images from T2-mapping revealing myocardial oedema in four, three and two-chamber views), as well as the absence of late gadolinium enhancement (supporting the idea that there was no irreversible myocardial injury).
Absence of irreversible tissue injury (late gadolinium enhancement) in four, three and two-chamber views.
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F5
All these elements were in favor of a final diagnosis of reverse TTS triggered by brainstem lesions of MS (Figure 5: absence of irreversible tissue injury (late gadolinium enhancement) in four, three and two-chamber views).