Did you know a stroke could cause EKG changes? Below is an example of an EKG showing inverted cerebral T waves as a consequence of an intracrantial hemorrhage (bleeding stroke). Cerebral T waves have been known to be symmetric and deeply inverted in patients with hemorrhagic strokes. This finding is not my normal presentation I see as a hospitalist, but when present, these deeply and symmetrically inverted T waves should alert the clinician to the possibility of a bleeding stroke. This patient had a cardiac echo confirming normal wall motion.
I don't know nor do I understand the physiology associated with inverted T waves on ECG from a hemorrhagic stroke. A residency attending physician told me years ago the ABIM had a question on this clinical exact scenario. They missed the question, but I don't think I ever will. I don't think a single resident from my program will ever miss this type of question ever again. Go here to review my collection of other interesting and educational EKGs.