Electrocardiographic patterns in patients with cerebrovascular accidents.

E LECTROCARDIOGRAPHIC changes without dem-lonstrable cardiac eause have beeni found in soimie patients with cerebrovascular accidents.1', These hallges have usually affeeted the T wave, which is flatteneed aucd oftenl inverted, not infrequently of a typically coroniary shape. Large. positive T waves have also beetn described. The T-wave alterations are muost clearly deinioiistrable in leads I, aVL, and V4 to V6. In addition, there have beeni isehemic changes in the RS-T segmllents, prolongation of the Q-T interval, anid large U waves. Thus, the eleetrocardiographic changes mnay resemble those seeni in acute rmiyocardial infaretion, anld misisnterpretation has led to a delay in operative treatient of subarachnoid hemnorrhage.2 These changes have beein reported predoninantly in patients with subarachnoid heniorrhage, but also in a few patients with othier forms of intracraniial bleeding. They have also been deseribed in one patienit with cerebral throm-bosis diagnosed on the basis of focal electroencephalographic abnormnalities4 and in three patients (of a group of 17) in whoi the neuropathologic diagnoses, based solely on elinical findings, were given as parenehymnal hemorrhage or arterial thrombosis.3 The most important cause of eleetrocardiographic changes in patients with cerebral accidents is of course heart disease, which is very comnnon in these cases and often a provocative factor. Frequently, it is difficult to be sure that electrocardiographic changes are not due to heart disease, possiblv latent, but rendered meanifest by anoxia. Other extraeerebral causes of circulatory, metabolic, or respiratory mlature, due to shoek, loss of fluid or electrolytes, changes in blood pressure, hepatic or renal disease, and accumilulation of