Electrocardiographic abnormalities in patients presenting with intracranial parenchymal haemorrhage

The electrocardiographic abnormalities associated with ischaemic stroke and subarachnoid haemorrhage have been described frequently and studied systematically; however, these changes were not investigated thoroughly in patients with intracranial parenchymal haemorrhage (IPH).

We retrospectively reviewed the electrocardiograms (ECGs) and medical records of all patients who had been diagnosed with acute intraparynchemal haemorrhage (IPH) between 2006 and 2009.

We included 160 patients (56% males). The median age was 71 years (interquartile range (IQR) 59 to 80) and 69% were above the age of 60 years. Most patients were hypertensive (81%).The majority of patients (86%) had at least one ECG abnormality. Sixty-eight (43%) patients had T-wave inversion and 65 (41%) had QTc interval prolongation. There was a significant association between QTc prolongation and the bleeding size and the presence of midline shift; odd ratios were 2.8 (CI 1.4 to 5.5; P 0.003) and 2.2 (CI 1.1 to 4.2; P 0.04), respectively. In addition, sinus tachycardia was found to be significantly associated with the presence of hydrocephalus (OR 4.1; CI 1.3 to 12.8; P 0.02).

ECG abnormalities are a common finding in patients with IPH. Repolarizaion abnormalities occur the most frequently. QTc prolongation was associated with bleeding size and midline shift. Patients who had hydrocephalus were more likely to have sinus tachycardia at presentation.