Global T wave inversions in a Patient with CVA


A middle-aged patient with no significant past history was brought in due to decrease LOC. BP in 200's systolic. PE showed right sided-weakness.


Image 1 - Baseline 12L 

Baseline 12L showed SR, LVH with strain.


Image 2- Follow-up ecg 

Follow-up 12L (days after) showed (symmetric) global T wave inversions with slightly prolonged QTc (485 ms). 

I came up with the work of Burch et al (1954) describing marked diffuse TW abnormalities in patients (n=17) with cerebral injury. 

Global TWI is not unique to cerebral injury as mentioned in the works of Walder LA and Spodick  DH.

For the case:

Lab showed CBC - normal range, Trop - neg, Na- 135, K -  3.5, Ca - 8.5 BUN/Crea-N, CXR - NAD, CT -image.


Image 3- CT of the head

CT of the head w/o contrast showed intraparenchymal hematoma centered within the left hemithalamus with intraventricular extension.

Echo: Mild concentric LVH, EF ~ 65, LA upper limits, RA, RV normal, no WMA.

Usual stroke management was initiated and shunt was inserted due to hydrocephalus. Patient was discharged after a few days.

Reference:

Burch et al. 1954. A New ECG Pattern Observed in CVA. Circ 9:719-723

Walder LA and Spodick DH. 1991. Global T wave inversion. JACC 17:1479-85

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