Neurology
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Figures Only
Right arrow Full Text (PDF)
Right arrow Correspondence:
Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Correspondence are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Muehlschlegel, S.
Right arrow Articles by Sims, J. R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Muehlschlegel, S.
Right arrow Articles by Sims, J. R., Jr
Related Collections
Right arrow CT
Right arrow Critical care
Right arrow All Cerebrovascular disease/Stroke
Right arrow Subarachnoid hemorrhage
Right arrow Cardiac
Right arrow Cardiac; see Cerebrovascular Disease/Cardiac
NEUROLOGY 2008;70:e28-e29
© 2008 American Academy of Neurology
Resident and Fellow Section

Teaching NeuroImage: Cerebral T-waves from an aneurysmal cardunculus compression

Susanne Muehlschlegel, MD, Richard P. Goddeau, Jr, DO and John R. Sims, Jr, MD

From the Department of Neurology (S.M., J.R.S.), Division of Neurocritical Care and Stroke, and Department of Radiology (J.R.S.), Massachusetts General Hospital, Harvard Medical School, Boston; and Department of Neurology (R.P.G.), University of Massachusetts Medical School, Worcester.

Address correspondence and reprint requests to Dr. John R. Sims, Massachusetts General Hospital, Departments of Neurology and Radiology, Division of Neurocritical Care and Stroke, CNY149 Room 6403, 13th Street, Charlestown, MA 02129 jsims{at}partners.org

A 41-year-old woman developed temporary substernal chest pain. Physical examination was normal. ECG showed diffuse T-wave inversions with nonfamilial/non-medication-related QTc prolongation (figure, A) persisting despite the resolution of chest pain after sublingual nitroglycerin. Normal serum/urine toxicology, cardiac enzymes, transthoracic echocardiogram, and resting Technetium-99m sestamibi study raised the suspicion for cerebral T-waves. Head CT/CT-angiogram (CTA) revealed a middle cerebral artery aneurysm compressing the cardunculus,1 in the right anterior inferior insula (figure, B and C). Partial ECG normalization (figure, D) by cardunculus decompression (1 month after aneurysm clipping) supports that it is the regulator of sympathetic cardiac outflow balance.1,2


Figure 121
View larger version (50K):
[in this window]
[in a new window]

  		Figure ECGs and head CT/CTA

Preoperative ECG shows diffuse T-wave inversions (QTc 459 msec) (A). Noncontrast head CT shows a right peri-insular hyperdensity (B, arrow); CTA shows one right middle cerebral artery aneurysm compressing the insula (arrow) and two other aneurysms (arrowheads) (C). Postoperative ECG shows reversal of T-waves in precordial leads (QTc 408 msec) (D).

 

Disclosure: The authors report no conflicts of interest.


   REFERENCES
Top.
 REFERENCES
 

  1. Samuels MA. "Voodoo" death revisited: the modern lessons of neurocardiology. Neurologist 1997;3:293–304.
  2. Oppenheimer SM, Gelb A, Girvin JP, Hachinski VC. Cardiovascular effects of human insular cortex stimulation. Neurology 1992;42:1727–1732.[Abstract/Free Full Text]




This Article
Right arrow Figures Only
Right arrow Full Text (PDF)
Right arrow Correspondence:
Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Correspondence are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Muehlschlegel, S.
Right arrow Articles by Sims, J. R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Muehlschlegel, S.
Right arrow Articles by Sims, J. R., Jr
Related Collections
Right arrow CT
Right arrow Critical care
Right arrow All Cerebrovascular disease/Stroke
Right arrow Subarachnoid hemorrhage
Right arrow Cardiac
Right arrow Cardiac; see Cerebrovascular Disease/Cardiac

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS