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NEUROLOGY 2006;66:99-101
© 2006 American Academy of Neurology
Medical Hypothesis

Cardiac encephalopathy and congestive heart failure

A hypothesis about the relationship

Louis R. Caplan, MD

From Beth Israel Deaconess Medical Center, Boston, MA.

Address correspondence and reprint requests to Dr. Louis R. Caplan, Palmer 127 West Campus, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215; e-mail: lcaplan{at}bidmc.harvard.edu

Many patients with congestive heart failure develop neurologic dysfunction. This may take the form of a cardiac encephalopathy that shares clinical features with other metabolic encephalopathies. The causes are multiple. There is a particular, previously unreported, syndrome that occasionally develops in some patients with congestive heart failure that resembles the findings in patients with normal pressure hydrocephalus. This syndrome is characterized by apathy and abulia with preserved alertness; it is caused by fluid retention within the cranial cavity. The syndrome may also develop in patients with other conditions that cause anasarca, e.g., severe liver or kidney disease or hypoalbuminemia. Because patients with these conditions are often quite ill, it has been difficult to verify the pathophysiologic aspects of the syndrome so that its mechanism must remain a hypothesis that awaits more definitive study in a series of patients. I have not seen this syndrome discussed in any cardiology or neurology texts or reports, and it seems to be completely unknown to cardiologists and neurologists. I have recognized about one patient per year with this syndrome.

Disclosure: The author reports no conflicts of interest.

Received June 7, 2005. Accepted in final form September 26, 2005.






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