Subendocardial Haemorrhage and E.C.G. Changes in Intracranial Bleeding

E.C.G. changes in connexion with intracranial (especially subarachnoidal) bleeding resembling those in myocardial infarction were first described by Burch et al. in 1954.The most typical change is a deep and broad T-U fusion wave in several leads.The explanation of the changes observed remains obscure (Effert et al., 1961).The purpose of this paper is to discuss the genesis of these E.C.G. changes on the basis of three cases in which both the typical E.C.G. changes and subendocardial haemorrhages were found. Case Reports Case 1A 54-year-old housewife who had previously been in good health was admitted on 29 November 1959.For the last three years she had gone swimming in winter-time in a hole cut in the ice-a type of winter sport not uncommon in Finland.After one such swim she suddenly collapsed and was brought to the hospital.Examination on admission showed a well-nourished woman with severe pulmonary oedema.The heart sounds were distant and there were no murmurs.Blood-pressure was 185/105 mm.Hg.Consciousness was clear and there were no signs of pareses.The E.C.G. on admission showed slightly negative T-waves in leads I, II, and V4 through V6.A myocardial infarction was suspected.She recovered quickly from the pulmonary oedema and felt better, except for increasing headache.On the following morning a slight stiffness of the neck was noticed and a lumbar puncture revealed bloody spinal fluid.A subarachnoidal haemorrhage was diagnosed.An E.C.G. now showed deep and wide negative T-U fusion waves in all leads except lead III, aVR, and V1, in which the fusion wave was positive (see Fig.).S.G.O.T. was normal on two successive days.During the days that followed the headache gradually diminished, the blood content of the spinal fluid decreased, and the E.C.G. changes became less severe.On the eighth day in hospital she had a second intracranial haemorrhage and died two days later.Necropsy revealed a ruptured aneurysm of the left internal carotid artery at the junction of the posterior communicating and middle cerebral arteries.The left temporal lobe showed some oedema and a few petechiae.The heart weighed 375 g.