23-46: “Cerebral” T Waves

ECG Findings

• Inverted, deep, and wide T waves are most notable in precordial leads (can be seen in any lead).

• QT interval prolongation.

• ST segment changes are variable.

• High-amplitude R waves.

• Arrhythmias may also occur in the setting of acute cerebral emergencies.

Pearls

1. These ECG changes are associated with increased intracranial pressure.

2. Cerebral T waves resolve spontaneously, but can persist up to 6 weeks.

3. Suspect increased intracranial pressure in patient presenting with altered mental status and the perviously mentioned ECG changes.