Main Abnormalities
Giant T-wave inversions in multiple leads, most prominent in V2-6
Marked QT prolongation > 600 ms
Diagnosis
This ECG pattern is characteristic of raised intracranial pressure and is classically seen in the context of massive intracranial haemorrhage, particularly:
Aneurysmal subarachnoid haemorrhage
Haemorrhagic stroke
Similar ECG patterns have also been reported in patients with raised ICP due to:
Large-territory ischaemic stroke causing cerebral oedema (e.g. MCA occlusion)
Traumatic brain injury
The differential diagnosis for widespread T-wave inversions and QT prolongation includes myocardial ischaemia (e.g. Wellen’s syndrome) and electrolyte abnormalities (e.g. hypokalemia). However, neither condition would cause the gigantic “cerebral T waves” seen here.
