Catastrophic neurologic syndrome with dramatic ECG changes

J Electrocardiol. 2014 Jan-Feb;47(1):80-3. doi: 10.1016/j.jelectrocard.2013.07.014. Epub 2013 Aug 21.

Abstract

Cerebrogenic ECG abnormalities, especially prominent T wave inversions and prolongation of the QT(U) interval, are well-described. Brady- and tachyarrhythmias, including polymorphic VT, have been also described in the setting of neurologic injury. We report an unusual case of a 22-year-old man who presented with idiopathic acute encephalopathy. His hospital course was complicated by persistent fevers, along with refractory seizures treated with propofol. Serial ECG findings included marked ventricular repolarization prolongation with bursts of torsade de pointes, diffuse ST elevations simulating extensive myocardial ischemia or infarction, as well as a Brugada-like pattern. To our knowledge, this case is the first reported with the combination of such findings in a patient with a catastrophic neurologic syndrome.

Keywords: Brugada pattern; Electrocardiogram; Polymorphic ventricular tachycardia; Propofol toxicity; Pseudo-infarct pattern; QT prolongation; Torsade de pointes.

Publication types

  • Case Reports
  • Research Support, N.I.H., Extramural

MeSH terms

  • Brugada Syndrome / complications*
  • Brugada Syndrome / diagnosis*
  • Catastrophic Illness
  • Confusion / complications*
  • Confusion / diagnosis*
  • Diagnosis, Differential
  • Electrocardiography / methods*
  • Humans
  • Male
  • Seizures / diagnosis*
  • Seizures / etiology*
  • Syndrome
  • Young Adult