title: Right sylvian fissure subarachnoid hemorrhage has electrocardiographic consequences.
abstract: OBJECTIVE
  Abnormal ECG changes are frequently observed in patients with subarachnoid hemorrhage (SAH). Recently, evidence has been obtained that right insular cortex mediates sympathetic cardiovascular effects. We therefore assessed the laterality and location of SAH dominance in inducing cardiovascular changes as measured by ECG, blood pressure, and heart rate.
  
  
  METHODS
  After exclusion of 11 SAH patients who died within 1 month after onset, we studied 118 consecutive patients. Data were obtained from records of blood pressure and pulse on admission. Abnormal ECG changes were determined from ECGs on admission and almost 1 month later. From brain CT scans performed immediately after admission, the amount of SAH in each of the 8 cisterns and fissures was measured semiquantitatively.
  
  
  RESULTS
  Twenty-six patients had abnormal changes on admission ECG, while 92 patients did not. Systolic blood pressure, diastolic blood pressure, and the amounts of blood in the left ambient cistern, left suprasellar cistern, quadrigeminal cistern, right ambient cistern, right suprasellar cistern, right sylvian fissure, and the set of all cisterns were significantly greater in the group with ECG change than in the group without ECG change. Multivariate logistic regression analysis with stepwise method indicated that systolic blood pressure >160 mm Hg (P=0.0006) and the amounts of SAH in the quadrigeminal cistern (P=0.022) and right sylvian fissure (P=0.0019) were independently associated with abnormal ECG change.
  
  
  CONCLUSIONS
  Cardiac consequences are possible in patients with massive right sylvian fissure SAH or when systolic blood pressure is >160 mm Hg.
authors.affiliation: Department of Neurosurgery, Toyama Medical and Pharmaceutical University, Toyama, Japan. yhira@ms.toyama-mpu.ac.jp
authors.forename: Y
authors.initials: Y
authors.lastname: Hirashima
authors.forename: S
authors.initials: S
authors.lastname: Takashima
authors.forename: N
authors.initials: N
authors.lastname: Matsumura
authors.forename: M
authors.initials: M
authors.lastname: Kurimoto
authors.forename: H
authors.initials: H
authors.lastname: Origasa
authors.forename: S
authors.initials: S
authors.lastname: Endo
mesh_terms: D001342:Autonomic Nervous System Diseases / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology*; D001794:Blood Pressure; D002540:Cerebral Cortex / Q000098:blood supply / Q000503:physiopathology*; D004292:Dominance, Cerebral; D004562:Electrocardiography; D005260:Female; D006321:Heart / Q000503:physiopathology; D006339:Heart Rate; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D014057:Tomography, X-Ray Computed