Electrocardiographic Changes Simulating Myocardial Ischemia and Infarction Associated with Spontaneous Intracranial Hemorrhage

AILTHOUGH a number of reports have IA~kappeared in the literature describing nonspecific S-T and T-wave changes in the electrocardiogram associated with neuromuscular disorders' electrolyte disturbances, hypoxemia, postprandial effects, etc., relatively few have appeared describing electrocardiographic changes, associated with intracranial hemorrhage. In 1947 Byer et al.2 described transitory changes (9 days) with large upright T waves and prolonged Q-T intervals in a patient with subarachnoid hemorrhage. In an extensive review of nonspecific T-wave changes Levine, in 1953, reported a case3 of subarachnoid hemorrhage which, at postmortem examination, was found to be due to a ruptured aneurysm in the circle of Willis. Although electrocardiographic changes considered to be associated with myocardial infaretion were present in this case, the heart was found to be normal at postmortem examination. Levine3 also referred to experimental studies of Beattie et al., who stimulated the basal ganglia and produced cardiac arrhythmias, and of Dikshit, who by intraventricular injection of caffeine produced ventricular extrasystoles with the associated S-T segment and T-wave changes. Levine concluded that the irregularities in rhythm were probably on the basis of vagal stimulation. In a very complete review of the literature Fulton4 summarized the effect of frontal lobe stimulation. The area that appears to be most intimately linked with the cardiovascular system was the orbital surface of the frontal lobe (area 13) and the anterior