Electrocardiographic abnormalities simulating myocardial infarction in intracerebral haemorhage and cerebral thrombosis.

During the past 15 years there have been a number of accounts of abnormal electrocardiograms recorded from patients who have cerebrovascular disturbance. Earlier reports dealt principally with subarachnoid haemorrhage. Levine (1953) referred to cascading T waves which became replaced by RS-T segment elevation in a patient who had a ruptured aneurysm of the circle of Willis. Burch, Meyers, and Abildskov (1954) found 10 abnormal electrocardiograms among the cerebrovascular accident admissions to a Louisiana hospital during the year 1950. Commoner abnormalities were a prolonged Q-T interval, T waves of increased amplitude and duration which were often negative, and sometimes large U waves. Later writers on the subject, such as Wasserman et al. (1956), described prolongation of the S-T interval and deep wide T waves which probably contained inverted U waves, but prolongation of the Q-T interval and wide upright T waves were also seen. Still more recent reviews of the subject have been those of Cropp and Manning (1960) and Hugenholtz (1962). The American authors mainly stress the absence of any clinical evidence of coronary infarction and the normality of the heart and coronary arteries at necropsy. Finnish authors (Koskelo, Punsar, and Sipild, 1964), however, suggest that subendocardial haemorrhages may occur more frequently than is generally believed. The series of Burch, Wasserman, and others contained patients with subarachnoid haemorrhage together with some cases of intracerebral haemorrhage. The purpose of this report is to describe an instance of intracerebral haemorrhage complicating thrombosis with abnormal electrocardiogram but normal heart and coronary arteries at necropsy.