Tall Cerebral T Waves

Report:

Sinus tachycardia

Prominent T waves

Nonspecific ST segment depression

Prolonged QT interval

Comment:

This question can only mean something in a specific context. The context was one of eventually fatal cerebral œdema associated with (?produced by) hyponatræmia in a young woman following minor surgery. It by now a distinct syndrome in its own right98.

Serum potassium remained normal throughout. Those who thought of hyperkalæmia would fail to explain the cerebral catastrophe; also the QT interval is too long. Combined hyperkalæmia and hypocalcæmia, seen in chronic renal failure patients? The context is wrong. Sodium of course has no direct effect on the electrocardiogram. The tall, admittedly peaked, T waves are of cerebral origin. Similar phenomenon, also in a young woman, has been recently described following head injury99.

Below is the patient’s trace taken 12 hours later (Fig 136a), when she was already (brain) dead. The T waves are still prominent, but within normal range apart from the prolonged QT interval.