A 45-year-old female was brought with sudden loss of consciousness and mental confusion. Clinical background revealed obesity and hypertension. She presented with acute respiratory failures, hypertense and comatose without focal deficits. Serial ECGs disclosed dynamic ST segment changes and neurogenic T waves. Cranial CT evinced extensive intraparenchymal hemorrhage in left cerebral hemisphere (Figure).
. First 12-lead ECG showing diffuse precordial neurogenic T waves (A - arrows). Cranial CT disclosing extensive intraparenchymal hemorrhage in left cerebral hemisphere with intraventricular extension and significant midline shift (B and C).
ST segment changes, QT prolongation and neurogenic or cerebral T waves are described in cerebrovascular events, generally related to subarachnoid and intracerebral hemorrhages1,2, originated from central dysautonomia3. ECG changes may help differentiating causes of decreased level of consciouness without focal deficits, if cerebrovascular disorders are considered.
References
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1Povoa R, Cavichio L, Almeida AL, et al. Electrocardiographic abnormalities in neurological diseases. Arq Bras Cardiol 2003;80(4):355-358.
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2Muehlschlegel S, Goddeau RP Jr., Sims JR Jr. Teaching neuroimage: cerebral T-waves from na aneurysmal cardunculus compression. Neurology 2008;70:28-29.
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3Mandrioli J, Zini A, Cavazzuti M, Panzetti P. Neurogenic T wave inversion in pure left insular stroke associated with hyperhomocysteinaemia. J. Neurol Neurosurg Psychiatry 2004;75:1788-1789.
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Financial disclosure: We have nothing to disclose.
Publication Dates
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Publication in this collection
June 2014
History
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Received
14 Nov 2013 -
Reviewed
03 Feb 2014 -
Accepted
24 Feb 2014
