In order to assess the relationship of electrocardiographic (ECG) changes in acute cerebrovascular accidents (CVA)to the locations of the cerebral lesions, ECGrecords and brain computerized tomographic(CT) scans which were taken within 48 hours of CVAonset were examined in 39 patients without heart disease and/or treatment with cardiovascular drugs. The ECGwas normal in 25%(3/12) of basal ganglial CVA, 22% (2/9) of frontal CVAand 36% (4/ll) of temporo-parietal CVA. Nonspecific ST-T changes occurred in basal ganglial CVA (25%), frontal CVA(22%), temporo-parietal CVA(18%) and in the other categories of CVAlocations. Corrected QTinterval (QTc) elongation was observed not only in frontal (22%), but also in basal ganglial CVA (25%), temporo-parietal CVA(36%) and cerebellar CVA(50%). There were no ECGchanges specific to a particular CVAlocation. These findings suggest that widely distributed neurons and pathways within the central nervous system may influence ECG.