[Electrocardiographic abnormalities in the setting of acute central nervous system pathology]

Up to 90% of patients with acute central nervous system lesions, such as stroke, exhibit secondary ECG abnormalities, including ST elevation/depression, T wave inversion, prominent U wave, prolonged QTc interval, sinus bradycardia/pause and atrioventricular block. The pathophysiology involves autonomic nervous system disturbance resulting in altered ventricular repolarization gradients, or even myocardial lesions. Clinical assessment aims at distinguishing asymptomatic neurogenic ECG abnormalities from organic heart conditions such as Takotsubo syndrome, myocardial infarction and chronic coronary syndromes. Serial ECG, cardiac biomarkers and echocardiography should be performed, followed by targeted work-up in selected patients. Prolonged QT, arrhythmias or hemodynamic compromise require continuous monitoring and standard management.