title: Catastrophic neurologic syndrome with dramatic ECG changes.
abstract: Cerebrogenic ECG abnormalities, especially prominent T wave inversions and prolongation of the QT(U) interval, are well-described. Brady- and tachyarrhythmias, including polymorphic VT, have been also described in the setting of neurologic injury. We report an unusual case of a 22-year-old man who presented with idiopathic acute encephalopathy. His hospital course was complicated by persistent fevers, along with refractory seizures treated with propofol. Serial ECG findings included marked ventricular repolarization prolongation with bursts of torsade de pointes, diffuse ST elevations simulating extensive myocardial ischemia or infarction, as well as a Brugada-like pattern. To our knowledge, this case is the first reported with the combination of such findings in a patient with a catastrophic neurologic syndrome.
authors: University of Washington School of Medicine, Harborview Medical Center, Seattle 98104, WA; Department of Internal Medicine, Division of Cardiology, Seattle 98104, WA.
authors: Zachary D
authors: ZD
authors: Goldberger
authors: University of Washington School of Medicine, Harborview Medical Center, Seattle 98104, WA; Department of Neurology, Seattle 98104, WA.
authors: Claire J
authors: CJ
authors: Creutzfeldt
authors: Division of Interdisciplinary Medicine and Biotechnology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston 02215, MA. Electronic address: zgoldber@uw.edu.
authors: Ary L
authors: AL
authors: Goldberger
mesh_terms: D053840:Brugada Syndrome / Q000150:complications* / Q000175:diagnosis*; D002388:Catastrophic Illness; D003221:Confusion / Q000150:complications* / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004562:Electrocardiography / Q000379:methods*; D006801:Humans; D008297:Male; D012640:Seizures / Q000175:diagnosis* / Q000209:etiology*; D013577:Syndrome; D055815:Young Adult
keywords: Brugada pattern; Electrocardiogram; Polymorphic ventricular tachycardia; Propofol toxicity; Pseudo-infarct pattern; QT prolongation; Torsade de pointes
references: Cell Mol Neurobiol. 2012 Jul;32(5):847-57
references: 22297544
references: Acta Anaesthesiol Scand. 1994 Apr;38(3):223-8
references: 8023660
references: Prog Cardiovasc Dis. 1993 Nov-Dec;36(3):245-60
references: 8234777
references: Br J Pharmacol. 2008 Sep;155(2):265-75
references: 18574460
references: Heart Rhythm. 2006 Feb;3(2):131-7
references: 16443524
references: Am Heart J. 1947 Jun;33(6):796-806
references: 20242366
references: Am J Surg. 1984 Jan;147(1):97-105
references: 6691557
references: Circulation. 2011 Mar 29;123(12):1270-9
references: 21403098
references: J Clin Neurosci. 2012 Mar;19(3):483-4
references: 22284924
references: Anesthesiology. 1999 Aug;91(2):512-20
references: 10443615
references: Heart Rhythm. 2009 Sep;6(9):1335-41
references: 19716089
references: Circulation. 2005 Sep 13;112(11):1527-31
references: 16144991
references: Circulation. 2007 Jul 3;116(1):77-84
references: 17606855
references: J Clin Anesth. 2012 Feb;24(1):51-4
references: 22284319
references: Mayo Clin Proc. 1998 Feb;73(2):148-52
references: 9472998
references: J Mol Cell Cardiol. 2010 Oct;49(4):543-53
references: 20659475
references: Br J Neurosurg. 1988;2(4):471-8
references: 3077053
references: Arch Phys Med Rehabil. 2001 Feb;82(2):246-9
references: 11239318
references: Am J Emerg Med. 2013 Jan;31(1):271.e5-7
references: 22809772
references: Arch Neurol. 1990 May;47(5):513-9
references: 2185720