Spiked helmet pattern ST elevation in subarachnoid hemorrhage

Area of Science:

• Cardiology
• Neurology
• Emergency Medicine

Background:

• Subarachnoid hemorrhage (SAH) can present with electrocardiographic (ECG) abnormalities that mimic acute myocardial infarction.
• Misinterpreting these ECG changes can lead to delayed diagnosis of SAH and inappropriate cardiac interventions.

Observation:

• A case report of a 40-year-old female presenting with ECG findings suggestive of ST-segment elevation myocardial infarction (STEMI).
• Further ECG analysis revealed QT interval prolongation and the characteristic "spiked helmet sign" (SHS).
• Head CT confirmed a massive SAH with intraventricular hemorrhage, ruling out myocardial infarction.

Findings:

• The "spiked helmet sign" (SHS) on ECG, along with QT prolongation, was associated with severe central nervous system (CNS) injury in this SAH case.
• Literature review and internal case files identified similar ECG patterns in other patients with acute CNS conditions.

Implications:

• Accurate interpretation of ECG findings in the context of neurological emergencies is vital.
• The SHS may serve as a potential biomarker for CNS injury, prompting further neurological investigation.
• Timely diagnosis of SAH prevents unnecessary and potentially harmful cardiac interventions.