Cerebral T Waves in ECG
Contents
- 1 Cerebral T Waves in ECG
- 2 1. What is the classical morphological feature of a cerebral T wave on ECG?
- 3 2. Cerebral T waves are most commonly seen in which ECG leads?
- 4 3. Which of the following is a typical clinical scenario where cerebral T waves may be observed?
- 5 4. What is the proposed mechanism for cerebral T wave changes?
- 6 5. Which of the following CNS events is least likely to cause cerebral T waves?
- 7 6. What differentiates cerebral T waves from ischemic T wave inversions?
- 8 7. Which of the following ECG abnormalities may accompany cerebral T waves?
- 9 8. In the setting of stroke, cerebral T waves are a predictor of:
- 10 9. The presence of cerebral T waves can mimic which cardiac condition?
- 11 10. Which condition must be excluded before attributing T wave inversion to a cerebral cause?
- 12 11. The timing of cerebral T waves typically corresponds to which phase of a stroke?
- 13 13. In which hemorrhagic CNS condition are cerebral T waves most prominently noted?
- 14 14. Which diagnostic tool is essential when cerebral T waves are suspected?
- 15 15. What is the implication of cerebral T waves in stroke patients?
- 16 16. What role do catecholamines play in cerebral T waves?
- 17 17. A 70-year-old with right-sided weakness shows deep T inversions in V2–V6. Troponins are normal. Next best step?
- 18 18. Which of the following is not part of the differential diagnosis of cerebral T waves?
- 19 19. Which population is most at risk for developing cerebral T waves?
- 20 20. Which ECG change typically resolves with recovery from stroke or CNS insult?
- 21 Cerebral T Waves in ECG
- 22 Cerebral T Waves in ECG
Cerebral T Waves in ECG
1. What is the classical morphological feature of a cerebral T wave on ECG?
A. Tall, peaked T waves
B. Flattened T waves
C. Deep, symmetrical, inverted T waves
D. Biphasic T waves
✅ Correct Answer: C
Explanation: Cerebral T waves are typically deep, symmetrical, and inverted, often found in precordial leads. They are suggestive of increased intracranial pressure or acute CNS insult.
2. Cerebral T waves are most commonly seen in which ECG leads?
A. Leads I and aVL
B. Inferior leads
C. Precordial leads V1–V6
D. aVR and aVL
✅ Correct Answer: C
Explanation: The precordial leads, especially V1–V4, are most commonly affected and show deep T wave inversions in cerebral T waves.
3. Which of the following is a typical clinical scenario where cerebral T waves may be observed?
A. Pulmonary embolism
B. Acute ischemic stroke
C. Aortic stenosis
D. Hyperkalemia
✅ Correct Answer: B
Explanation: Acute ischemic stroke, especially involving large vessels like MCA, may produce cerebral T waves due to neurocardiogenic effects.
4. What is the proposed mechanism for cerebral T wave changes?
A. Coronary vasospasm
B. Electrolyte imbalance
C. Neurogenic myocardial stunning
D. AV node dysfunction
✅ Correct Answer: C
Explanation: Neurogenic myocardial stunning caused by increased sympathetic stimulation during acute brain injury leads to T wave changes.
5. Which of the following CNS events is least likely to cause cerebral T waves?
A. Subarachnoid hemorrhage
B. Intracerebral hemorrhage
C. Acute spinal cord injury
D. Large ischemic stroke
✅ Correct Answer: C
Explanation: While brain injuries often cause cerebral T waves, spinal cord injury is less likely to directly induce neurogenic ECG changes.
6. What differentiates cerebral T waves from ischemic T wave inversions?
A. T wave morphology
B. Associated ST elevation
C. Symmetry and distribution of T wave inversions
D. Timing of appearance
✅ Correct Answer: C
Explanation: Cerebral T waves are typically deep, symmetrical, and diffuse, while ischemic T inversions are often asymmetrical and localized to the ischemic area.
7. Which of the following ECG abnormalities may accompany cerebral T waves?
A. QT prolongation
B. J-point elevation
C. Short PR interval
D. U waves
✅ Correct Answer: A
Explanation: QT prolongation may be observed alongside cerebral T waves due to autonomic dysfunction.
8. In the setting of stroke, cerebral T waves are a predictor of:
A. Seizure activity
B. Brain herniation
C. Cardiac arrhythmias
D. Cerebellar infarction
✅ Correct Answer: C
Explanation: These ECG changes are associated with an increased risk of cardiac arrhythmias in the setting of acute neurologic injury.
9. The presence of cerebral T waves can mimic which cardiac condition?
A. Pericarditis
B. Anterior myocardial infarction
C. Left ventricular hypertrophy
D. Brugada syndrome
✅ Correct Answer: B
Explanation: The T wave inversions can mimic anterior MI, making clinical correlation and neuroimaging essential in stroke patients.
10. Which condition must be excluded before attributing T wave inversion to a cerebral cause?
A. Left atrial enlargement
B. Myocardial ischemia
C. Bundle branch block
D. Atrial fibrillation
✅ Correct Answer: B
Explanation: Myocardial ischemia is the most common cause of T wave inversion and must be ruled out before labeling them as cerebral T waves.
11. The timing of cerebral T waves typically corresponds to which phase of a stroke?
A. Pre-ictal phase
B. Acute onset
C. Recovery phase
D. Chronic phase
✅ Correct Answer: B
Explanation: These changes occur early during the acute phase of a stroke or CNS insult.
12. Which part of the brain is most associated with neurocardiogenic ECG changes?
A. Occipital cortex
B. Hypothalamus
C. Parietal lobe
D. Cerebellum
✅ Correct Answer: B
Explanation: The hypothalamus regulates autonomic function and can mediate the neurogenic cardiac effects that cause ECG abnormalities.
13. In which hemorrhagic CNS condition are cerebral T waves most prominently noted?
A. Epidural hematoma
B. Subdural hematoma
C. Subarachnoid hemorrhage (SAH)
D. Intramedullary hemorrhage
✅ Correct Answer: C
Explanation: SAH is classically associated with dramatic ECG changes including cerebral T waves, due to catecholamine surge.
14. Which diagnostic tool is essential when cerebral T waves are suspected?
A. Coronary angiography
B. Brain imaging (CT or MRI)
C. Electrophysiologic study
D. Holter monitor
✅ Correct Answer: B
Explanation: Neuroimaging is critical to identify the underlying neurologic cause of the T wave abnormalities.
15. What is the implication of cerebral T waves in stroke patients?
A. Predicts a smaller infarct size
B. Benign finding
C. Marker of poor prognosis
D. Indicates hemorrhagic conversion
✅ Correct Answer: C
Explanation: Their presence is associated with more severe stroke and higher likelihood of complications like arrhythmias.
16. What role do catecholamines play in cerebral T waves?
A. Inhibit myocardial depolarization
B. Increase vagal tone
C. Induce myocardial repolarization abnormalities
D. Reduce cardiac output
✅ Correct Answer: C
Explanation: Excess catecholamine release from CNS injury alters myocardial repolarization, leading to T wave inversion.
17. A 70-year-old with right-sided weakness shows deep T inversions in V2–V6. Troponins are normal. Next best step?
A. Cardiac catheterization
B. Repeat troponin in 12 hours
C. Urgent brain imaging
D. Treat as STEMI
✅ Correct Answer: C
Explanation: In the absence of biochemical evidence of MI, brain imaging is warranted to rule out acute stroke.
18. Which of the following is not part of the differential diagnosis of cerebral T waves?
A. Takotsubo cardiomyopathy
B. Early repolarization
C. Wellen’s syndrome
D. CNS hemorrhage
✅ Correct Answer: B
Explanation: Early repolarization causes ST elevation but not deep symmetrical T wave inversions.
19. Which population is most at risk for developing cerebral T waves?
A. Elderly with atrial fibrillation
B. Patients with epilepsy
C. Patients with acute CNS insults like stroke or SAH
D. Diabetics with neuropathy
✅ Correct Answer: C
Explanation: Acute brain injuries such as stroke and subarachnoid hemorrhage are high-risk scenarios.
20. Which ECG change typically resolves with recovery from stroke or CNS insult?
A. PR prolongation
B. Cerebral T wave inversion
C. RBBB pattern
D. Q wave formation
✅ Correct Answer: B
Explanation: Cerebral T waves are usually reversible and resolve as the brain injury recovers or is managed.
Cerebral T Waves in ECG
Cerebral T Waves in ECG
# | Point |
---|---|
1 |
DefinitionCerebral T waves are deep, symmetrical, inverted T waves seen in the ECG, usually related to acute central nervous system (CNS) events. |
2 |
Classic Leads AffectedMost commonly seen in precordial leads V1–V6, especially V3–V5. |
3 |
MorphologyT waves are typically deep, symmetrical, and inverted — sometimes >10 mm depth. |
4 |
Common CausesSubarachnoid hemorrhage, large ischemic strokes, and intracerebral hemorrhage. |
5 |
MechanismCatecholamine surge and neurogenic myocardial stunning following brain injury. |
6 |
Associated ECG ChangesQT prolongation, ST depression, U waves, and possible arrhythmias. |
7 |
Neuroanatomy LinkHypothalamus and insular cortex are responsible for autonomic cardiac modulation. |
8 |
Clinical MimicCan mimic anterior myocardial infarction (MI), especially STEMI. |
9 |
Important DifferentialWellen’s syndrome – also causes deep anterior T inversions but is cardiac in origin. |
10 |
ResolutionUsually resolves within days to weeks as CNS injury improves. |
11 |
Clinical ImplicationMay indicate severe CNS pathology and predict worse neurologic outcomes. |
12 |
Risk of ArrhythmiaThese patients are at higher risk for ventricular arrhythmias and sudden cardiac death. |
13 |
Stroke Type AssociationMore commonly associated with large vessel strokes like MCA infarctions. |
14 |
Timing of AppearanceOccurs early in the course of acute neurologic insult. |
15 |
Troponin LevelsMay be mildly elevated due to neurogenic myocardial injury without true ischemia. |
16 |
False Diagnosis RiskMisinterpreting cerebral T waves as MI can lead to inappropriate anticoagulation. |
17 |
Additional MonitoringThese patients often need cardiac telemetry and QT monitoring. |
18 |
Diagnosis ConfirmationRequires clinical context and neuroimaging (CT/MRI brain) for confirmation. |
19 |
ReversibilityChanges are typically transient and non-ischemic, reversible with treatment of CNS insult. |
20 |
Take-Home MessageAlways correlate ECG findings with neurologic symptoms to avoid misdiagnosis. |