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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.

FIGURE 23.46A

Cerebral T Waves. This ECG was obtained on a patient with a severe acute hemorrhagic cerebrovascular accident. (ECG contributor: James V. Ritchie, MD.)

FIGURE 23.46B

Deep, symmetrical, inverted T waves (arrowhead) with a prolonged QT interval.

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