Young male found collapsed at home, apparently intoxicated. What does the ECG show?
Describe and interpret this ECG
ECG ANSWER and INTERPRETATION
- Giant T-wave inversions in multiple leads, most prominent in V2-6
- Marked QT prolongation > 600 ms
ECG pattern is characteristic of raised intracranial pressure and is classically seen in the context of massive intracranial haemorrhage, particularly:
- Aneurysmal subarachnoid haemorrhage
- Haemorrhagic stroke
Similar ECG patterns have also been reported in patients with raised ICP due to:
- Large-territory ischaemic stroke causing cerebral oedema (e.g. MCA occlusion)
- Traumatic brain injury
The differential diagnosis for widespread T-wave inversions and QT prolongation includes myocardial ischaemia (e.g. Wellens syndrome) and electrolyte abnormalities (e.g. hypokalemia). However, neither condition would cause the gigantic “cerebral T waves” seen here.