In recent years, it has been convincingly demonstrated that acute brain injury may cause severe cardiac complications-such as neurogenic stress cardiomyopathy (NSC), a specific form of takotsubo cardiomyopathy. The pathophysiology of these brain-heart interactions is complex and involves sympathetic hyperactivity, activation of the hypothalamic-pituitary-adrenal axis, as well as immune and inflammatory pathways. There have been great strides in our understanding of the axis from the brain to the heart in patients with isolated acute brain injury and more specifically in patients with stroke. On the other hand, in patients with NSC, research has mainly focused on hemodynamic dysfunction due to arrhythmias, regional wall motion abnormality, or left ventricular hypokinesia that leads to impaired cerebral perfusion pressure. Comparatively little is known about the underlying secondary and delayed cerebral complications. The aim of the present review is to describe the stroke-heart-brain axis and highlight the main pathophysiological mechanisms leading to secondary and delayed cerebral injury in patients with concurrent hemorrhagic or ischemic stroke and NSC as well as to identify further areas of research that could potentially improve outcomes in this specific patient population.

中文翻译：

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心脏处于危险之中：了解中风-心-脑相互作用，重点关注神经源性应激性心肌病-综述。

近年来，令人信服的证据表明，急性脑损伤可能会导致严重的心脏并发症——例如神经源性应激性心肌病 (NSC)，这是章鱼坪心肌病的一种特殊形式。这些脑-心相互作用的病理生理学是复杂的，涉及交感神经过度活跃、下丘脑-垂体-肾上腺轴的激活，以及免疫和炎症通路。我们对孤立性急性脑损伤患者（尤其是中风患者）从大脑到心脏的轴的理解有了长足的进步。另一方面，在 NSC 患者中，研究主要集中在由于心律失常、局部室壁运动异常或左心室运动功能减退导致脑灌注压受损引起的血流动力学功能障碍。对潜在的继发性和迟发性脑并发症知之甚少。本综述的目的是描述卒中-心-脑轴，强调导致并发出血性或缺血性卒中和 NSC 患者继发性和迟发性脑损伤的主要病理生理机制，并确定可以进一步研究的领域可能改善这一特定患者群体的结果。