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

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

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

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

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