Electrocardiographic abnormalities in neurological diseases

Abstract

Original ArticleCentral nervous system disorders are known to be responsible for the onset of cardiac alterations, frequently observed in the electrocardiogram 1,2 . Although serum potassium disturbance has been suggested as an important factor in these alterations, this finding was not confirmed in several studies 3,4 . The majority of studies suggest that these ECG abnormalities result from disturbances in the autonomous system, due to neurologic disease, promoting a local excess of catecholamines, associated with enhanced adrenal production, and activation of the calcium channels, leading to an increase in cytosolic and mitochondrial calcium, as well as release of free radicals, causing contraction band necrosis and reflected in ECG alterations. Although the causes of cardiac alterations are a matter of scientific speculation, evidence exists that myocardial lesion is mediated by catecholamines, and an important left ventricle dysfunction with the liberation of cardiac enzymes, such as troponin-I, occurs in some cases 5 . The increase in intracranial pressure is also considered a factor in these alterations 6 . Data described by Goldstein 7 in a certain population demonstrated a high incidence (up to 92%) of electrocardiogram alteration in neurological disorders. This result was not observed in clinical practice. In our study, we observed a frequency of electrocardiogram alterations in pathological brain processes contrary to that observed in the literature. MethodsWe carried out a study for 6 years of 1,590 patients admitted because of neurological diseases, such as brain tumor, stroke, subarachnoid hemorrhage, subdural hemorrhage, brain aneurysm, and head injury, with ages ranging from 10 to 60 years. Patients with concomitant diseases that could lead to electrocardiogram alterations, such as systemic hypertension, cardiac valve abnormalities, coronary diseases, congenital cardiopathies, endocrine diseases, and others were excluded. Those patients who did not have a complete clinical history or an electrocardiogram performed at the time of admittance were also excluded. A cardiologist unaware of the neurological diseases and any other clinical data regarding the patient interpreted the elec-

The Irreversible Neurogenic Stress Cardiomyopathy During Large Supratentorial Brain Tumor Resection

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Electrocardiographic changes in patients with raised intracranial pressure from supratentorial brain tumors

“…[7,8] Other studies have reported incidence of sinus bradycardia in 4-12% of patients with brain tumors. [17][18][19] In our study, the repolarization abnormalities, that is, ST-segment depression, ST elevation, and T-wave changes, were found in 12, 16, and 16%, respectively, of Group 2 patients. e cellular mechanism for the repolarization changes in acute neurological conditions has been attributed to the sympathetic hyperactivity and the resultant release of large volumes of norepinephrine from the sympathetic nerve terminals.…”

Electrocardiographic changes following intracranial haemorrhage: a retrospective cohort study

“…Abnormalities associated with ischemia, such as ST-segment changes, T-wave inversions, and arrhythmias were observed only in a few cases. [28][29][30] In our study, 72.4% of the ECG's were abnormal. Patients with SDH were the only ones with Q waves or left axis deviation or bundle branch blocks )3% and 21.2%, respectively(.…”