Transient Cardiac Dysfunction Following a Cerebrovascular Accident

Abstract

Acute cerebral injuries are often accompanied by sudden electrocardiogram (ECG) changes such as cardiac arrhythmias, QT prolongation, and abnormal T-wave morphology. One rare phenomenon is "cerebral T-waves", which are T-waves observed in the context of stroke and described as transient, symmetric, and deeply inverted. The classic cerebral T wave is defined as a T-wave inversion of ≥5 mm depth in at least four contiguous precordial leads, and it is more commonly observed in the setting of acute ischemic stroke rather than hemorrhagic stroke. We describe the case of a patient who initially presented with acute pulmonary edema, T-wave inversions in the precordial leads, and left ventricular dysfunction on echocardiogram raising suspicion of an ischemic cardiac event. However, a brain CT scan performed on the third day of admission proved us wrong.

Keywords: cardiac arrythmia; cerebral t waves; cerebro-vascular accident (stroke); left ventricular systolic dysfunction; t-waves.

Figure 1. ECG showing T-wave inversions over the pericordial leads (black arrows).

Figure 2. CT scan on the second day of admission showing large evolving infarct within left temporal and left parietal lobe (yellow arrows).

Figure 3. ECG showing the resolution of the T-wave inversions on the third day of hospital stay (black arrows).