1. 1 Copyright © 2014 Elsevier Inc. All rights reserved. Chapter 10 Cardiac Manifestations of Acute Neurologic Lesions NERISSA U. KO

2. 2 Copyright © 2014 Elsevier Inc. All rights reserved. Figure 10-1 Typical “neurogenic” electrocardiographic changes with symmetric deep T-wave inversions in a patient with acute subarachnoid hemorrhage. These abnormalities were transient and not associated with myocardial infarction. (Courtesy of Dr. Jonathan Zaroff, MD.)

3. 3 Copyright © 2014 Elsevier Inc. All rights reserved. Figure 10-2 Electrocardiographic (ECG) changes can precede pathologic arrhythmias in patients with severe neurologic injuries. A, Prolongation of the QT interval is common after subarachnoid hemorrhage. Electrolyte abnormalities or medications can also prolong the QT interval. B, Torsades de pointes is a polymorphic ventricular tachycardia associated with QT prolongation. (Courtesy of Dr. Byron Lee, MD.)

4. 4 Copyright © 2014 Elsevier Inc. All rights reserved. Figure 10-3 A representative cross-section of myocardium after hematoxylin–eosin stain showing marked myocyte hypertrophy with nucleomegaly, and myocytolysis. (Courtesy of Dr. Philip Ursell, MD.)

5. 5 Copyright © 2014 Elsevier Inc. All rights reserved. Figure 10-4 Normal myocardial innervation (A) and perfusion (B) in a 71-year-old man with SAH. Global functional denervation (C) and normal perfusion, except for a nonspecific apical irregularity (D), in a 41-year-old woman with SAH. (From Banki NM, Kopelnik A, Dae MW, et al: Acute neurocardiogenic injury after subarachnoid hemorrhage. Circulation 112:3314, 2005, with permission.)

6. 6 Copyright © 2014 Elsevier Inc. All rights reserved. Figure 10-5 Serum B-type natriuretic peptide (BNP) levels and cardiac outcomes. The column height indicates the mean BNP and the error bars indicate 95% confidence intervals. Probability values indicate results of Wilcoxon rank-sum tests. cTi, cardiac troponin I more than 1.0 μg/L; EF, left ventricular ejection fraction less than 50%; RWMA, regional wall motion abnormality. (From Tung PP, Olmsted E, Kopelnik A, et al: Plasma B-type natriuretic peptide levels are associated with early cardiac dysfunction after subarachnoid hemorrhage. Stroke 36:1567, 2005, with permission.)