Related Experiment Video
Updated: Aug 7, 2025
A Bedside, Single Burr Hole Approach to Multimodality Monitoring in Severe Brain Injury
Published on: March 26, 2019
Electrocardiographic changes in patients with raised intracranial pressure from supratentorial brain tumors
Manikandan Sethuraman1, Ajay Prasad Hrishi1, Unnikrishnan Prathapadas1
1Division of Neuroanaesthesia, Department of Anaesthesia, Sree Chitra Tirunal Institute of Science and Technology, Trivandrum, Kerala, India.
Insights
Patients with brain tumors and raised intracranial pressure (ICP) show significantly more electrocardiogram (ECG) changes, including arrhythmias and repolarization abnormalities, compared to those without ICP. This highlights a critical link between neurological status and cardiac health.
Area of Science:
- Neurology
- Cardiology
- Neurosurgery
Background:
- Electrocardiogram (ECG) changes are common in neurological emergencies like stroke and head trauma.
- Literature on cardiac dysfunction due to raised intracranial pressure (ICP) from brain tumors is limited.
- This study investigates ECG changes associated with intracranial hypertension in supratentorial brain tumors.
Purpose of the Study:
- To observe and analyze electrocardiogram (ECG) changes in patients with supratentorial brain tumors.
- To determine the incidence of cardiac dysfunction in relation to intracranial pressure (ICP).
- To compare ECG abnormalities between patients with and without raised ICP.
Main Methods:
- Prospective observational study of 100 patients with supratentorial brain tumors.
- Patients divided into two groups: with and without clinical/radiological signs of raised ICP.
- 12-lead ECGs analyzed using the standardized Minnesota code; statistical analysis performed.
Main Results:
- 32% of patients with raised ICP had abnormal ECGs, versus 6% without ICP (P < 0.05).
- Significantly higher incidence of sinus bradycardia, ST-segment depression, ST-segment elevation, and T-wave abnormalities in the raised ICP group.
- Repolarization abnormalities and arrhythmias were more frequent in patients with elevated ICP.
Conclusions:
- Patients with supratentorial tumors and raised ICP exhibit a higher frequency of ECG changes.
- Intracranial hypertension is associated with increased cardiac repolarization abnormalities and arrhythmias.
- Findings underscore the importance of cardiac monitoring in brain tumor patients with elevated ICP.
Objectives:
A wide variety of electrocardiographic (ECG) changes has been described in the context of neurological catastrophe. There has been diverse and plentiful literature emphasizing the cardiac changes in acute cerebrovascular events and traumatic brain injury. In stark contrast, there is scarce literature on the incidence of cardiac dysfunction caused by raised intracranial pressure (ICP) resulting from brain tumors. The study aimed to observe the ECG changes concurrent with intracranial hypertension resulting from supratentorial brain tumors.
Materials And Methods:
This is a pre-specified subgroup analysis of a prospective and observational study on cardiac function in patients presenting for neurosurgery. Data of 100 consecutive patients of either sex between 18 and 60 years who presented with primary supratentorial brain tumors were analyzed. The patients were divided into two groups: Group 1 consisted of patients without clinical and radiological features of raised ICP and Group 2 consisted of patients with clinical and radiological features of raised ICP. A 12-lead ECG was obtained for every patient on the day before the neurosurgical procedure as part of the pre-anesthetic assessment. The cardiologist and the neuroanesthetist independently examined the ECG, and it was then classified and coded as per the standardized Minnesota code. Statistical analysis was performed with IBM SPSS (release 22.0; IBM Corp., Armonk, NY, USA). The normality of the distribution of continuous variables was tested using the Shapiro-Wilk test. Normally distributed variables were expressed as Mean ± SD. All nominal or categorical variables are described as frequencies and percentages. Categorical variables were compared using the Chi-square test or the Fisher's exact test. The normally distributed continuous variables were compared using Student's t-test. "P < 0.05" was considered statistically significant.
Results:
About 6% in Group 1 and 32% in Group 2 had abnormal ECG. This was significantly different in Group 2 compared to Group 1 (P < 0.05). No patients in Group 1 had sinus bradycardia, whereas it was observed in 12% of the patients in Group 2 (P = 0.02). ST-segment depression was found in 12% of patients in Group 2, whereas none had it in Group 1 (P = 0.02). ST-segment elevation was noticed in 16 % in Group 2 and 2% in Group 1 (P = 0.01). T-wave abnormalities were found in 16% compared to 4% in Group 1 (P = 0.03).
Conclusion:
In patients with supratentorial tumors, we observed that those with raised ICP had a higher incidence of ECG changes than those with normal ICP. In addition, repolarization abnormalities and arrhythmias were significantly higher in patients with raised ICP.
