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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282X

Arq. Neuro-Psiquiatr. vol.72 no.6 São Paulo June 2014 

Images in Neurology

Neurogenic T waves as clues for diagnosing hemorrhagic stroke

Ondas T neurogênicas como guias para diagnóstico de AVC hemorrágico

Wladimir Bocca Vieira de Rezende Pinto1 

Lucas Amorim Vieira de Barros1 

Paulo Victor Sgobbi de Souza1 

José Luiz Pedroso1 

Orlando Graziani Povoas Barsottini1 

1Departamento de Neurologia, Universidade Federal de São Paulo, Sao Paulo SP, Brazil.

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).

Figure . First 12-lead ECG showing diffuse precordial neurogenic T waves (A - arrows). Cranial CT disclosing extensive intraparenchymal hemorrhage in left cerebral hemisphere with intraventricular extension and significant midline shift (B and C). 

ST segment changes, QT prolongation and neurogenic or cerebral T waves are described in cerebrovascular events, generally related to subarachnoid and intracerebral hemorrhages1,2, originated from central dysautonomia3. ECG changes may help differentiating causes of decreased level of consciouness without focal deficits, if cerebrovascular disorders are considered.


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. Muehlschlegel S, Goddeau RP Jr., Sims JR Jr. Teaching neuroimage: cerebral T-waves from na aneurysmal cardunculus compression. Neurology 2008;70:28-29. [ Links ]

. Mandrioli J, Zini A, Cavazzuti M, Panzetti P. Neurogenic T wave inversion in pure left insular stroke associated with hyperhomocysteinaemia. J. Neurol Neurosurg Psychiatry 2004;75:1788-1789. [ Links ]

Financial disclosure: We have nothing to disclose.

Received: November 14, 2013; Revised: February 03, 2014; Accepted: February 24, 2014

Correspondence: Wladimir Bocca Vieira de Rezende Pinto; Rua Botucatu, 740; 04023-900 São Paulo SP, Brasil; E-mail:

Conflict of interest: There is no conflict of interest to declare.

Creative Commons License This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.