Alterations in cardiac depolarisation and repolarisation are reported in 74% of patients with cerebrovascular events.¹ They are more frequent after subarachnoid and intracerebral haemorrhage, but may also occur in acute ischaemic stroke (15–30%) and are related to an increased incidence of malignant arrhythmia and sudden death (6%).²

The most common ECG alterations are QT prolongation, ST segment alterations, T wave flattening or inversion, and abnormal U waves.¹ ECG changes may be similar to those commonly observed in patients with coronary artery disease,² but they have also been demonstrated in the absence of autopsy proven heart disease.¹ This suggests a neurogenic rather than a primary cardiac cause, mediated by unbalanced autonomic control.

Experimental evidence implicates the insular cortex in cardiovascular control and heart chronotropic organisation,² and suggests its involvement in the genesis of adverse neurogenic ECG alterations.

Case report

A 68 year old right handed female was admitted after the acute onset of mild right ataxic hemiparesis, right facial and hypoglossal nerve palsy, and dysarthria. The patient was vegetarian, had no history of diabetes or cardiac disease, and was a non-smoker without relevant family history. Blood pressure was 150/100 mm Hg and heart rate (HR) was 94 beats per minute (bpm). The admission brain CT and Doppler ultrasounds were normal. A left anterior hemiblock was detected at ECG …