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.
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