Cerebral T wave on ECG in a patient with stroke

Cerebral T wave, represents transient, deep, symmetrical, negative T wave on the electrocardiogram (ECG), in patients with stroke. It is important to recognize the cerebral T wave, differentiate it from other disorders presenting with negative T waves, and thus avoid the pitfall of acute coronary syndrome misdiagnosis, and wrong therapy selection (i.e. fibrinolytic, anticoagulant and antithrombotic), which would be very dangerous for a patient with cerebral hemorrhage. The female patient, 84 years old, was hospitalized due to a hip fracture to the orthopedic department of the Health center Zajecar hospital. Her past medical history was remarkable for treated arterial hypertension and paroxysmal atrial fibrillation. She was hemodynamically stable and asymptomatic. As part of the preoperative management, an internist consultation was sought due to newly developed ECG abnormalities: sinus rhythm, HR of 65/min, left bundle branch block (LBBB) and negative T waves of 5mm in the precordial leads. There were echocardiographic wall motion abnormalities of the left ventricle. Hs troponin level was 278 ng/ml and acute coronary syndrome was suspected. The patient was started on ACE inhibitor, beta-blocker, statin and dual antiplatelet therapy. The patient develops right-sided muscle weakness. Brain CT was done and the zone of left low temporoccipital acute ischemia was described. The patient gave the informed consent for coronary angiography this time and after stabilization it was performed. The angiographic findings were normal. Consequently, with optimized medical therapy, she was returned to orthopedics for further orthopedic care.