Most commonly seen in the setting of acute stroke or cerebrovascular accident, intracranial hemorrhage, subarachnoid hemorrhage, or after carotid endarterectomy, neurologic injury can result in the following ECG changes:

1. Diffuse deeply inverted T waves
2. Prolonged QT interval

These changes may mimic ischemia. There is debate regarding the risk for the prolonged QT interval leading to polymorphic ventricular tachycardia in this setting.

ECG Examples:

• Neurologic Insult ECG Example 1
• Neurologic Insult ECG Example 2

• Neurologic Insult ECG Example 3

References:

1. Chou's Electrocardiography in Clinical Practice: Adult and Pediatric, Sixth Edition, Saunders, Philadelphia, 2008.

2. Surawicz B et al. ACC/AHA recommendations for the standardization and interpretation of the electrocardiogram. Circulation. 2009;119:e235-240.