Takotsubo Syndrome Following Emergency Decompression for Acute Cervical Spinal Epidural Hematoma: A Case Report

BACKGROUND Spinal epidural hematoma is a rare emergency that can occur after minor neck movement and involve the cervical and upper thoracic levels, potentially causing autonomic imbalance. Takotsubo syndrome is a transient stress-related left ventricular dysfunction that can occur after acute neurologic disorders and perioperative physiological stress; however, postoperative takotsubo syndrome following decompressive surgery for spinal epidural hematoma is rarely described. CASE REPORT A 79-year-old woman with type 2 diabetes and hypertension developed quadriparesis after minor neck rotation. Magnetic resonance imaging revealed a dorsal epidural hematoma from C2 to T3, and she underwent emergency C2-C5 hemilaminectomy and hematoma evacuation. On postoperative day 1, new T-wave inversions and elevated troponin levels were detected. Transthoracic echocardiography showed apical akinesis with basal hyperkinesis, while coronary angiography showed no flow-limiting lesions. Based on transient regional wall-motion abnormalities beyond a single coronary territory, absence of obstructive coronary artery disease, and subsequent recovery, postoperative takotsubo syndrome was diagnosed. She recovered with supportive care and was discharged for rehabilitation. CONCLUSIONS Postoperative takotsubo syndrome can occur after emergency decompressive surgery for acute cervical spinal epidural hematoma, possibly reflecting combined neurogenic and perioperative stress. Clinicians should remain vigilant for postoperative myocardial dysfunction in selected high-risk patients with acute cervical spinal pathology.