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A 45-year-old female was brought with sudden loss of consciousness and mental confusion. Clinical background revealed obesity and hypertension. She presented with acute respiratory failures, hypertense and comatose without focal deficits. Serial ECGs disclosed dynamic ST segment changes and neurogenic T waves. Cranial CT evinced extensive intraparenchymal hemorrhage in left cerebral hemisphere (Figure). ST segment changes, QT prolongation and neurogenic or cerebral T waves are described in cerebrovascular events, generally related to subarachnoid and intracerebral hemorrhages, originated from central dysautonomia. ECG changes may help differentiating causes of decreased level of consciouness without focal deficits, if cerebrovascular disorders are considered.

Neurogenic T waves as clues for diagnosing hemorrhagic stroke