A 19yr old white male, s/p cardiac arrest, now with transtentorial herniation.
As with this case, ECG patterns in the context of acute CNS disease have been primarily associated with ventricular repolarization, i.e. the morphology of the QT segment and T-wave, and the presence of prominent U-waves (not present here). Although little sensitivity or specificity has been accorded to this connection, the phenomenon raises interesting questions of nerocardiac interrelation. Most explicitly, bradycardia as a result of hypervagotonia is often noted in the setting increased intracranial pressure. Yet more difficult to explain are the deep, symmetrical T-wave inversions and prolonged Q-T frequently described as more specific indicators of intracranial pathology. It has been hypothesized that these effects are due to an autonomicaly mediated catocholamine surge causing transient coronary vasospasm and subsequent myocardial ischemia.
The ST segments in this case are of a somewhat novel morphology, perhaps even reminiscent of the scooped out troughs seen as a common Digitalis effect.
This pt. was taken to the OR for withdrawal of ventilatory support and organ donation later in the night.