ST changes with intracranial bleed

[zzyzx]

The other day I transported a patient with an intracranial bleed from one ER to another. I told the receiving doctor that the patient had also shown ST elevation in a few leads (If I remember correctly it was S1 and S2) on a 12-lead that the first ER had taken. He told me that it was quite common for people with intracranial bleeds to present with ST changes and other ECG changes.

Does anyone know why this happens?

(I could just research this myself on the net, but I figure this topic might be of interest to others.)

[AZCEP]

S1 and S2???

I'm not familiar with those leads. Did you perhaps mean V1 and 2?

It is not unusual for IC bleeds to have some ST depression, but the development of ST elevation would stand to reason. I've transported several with ST depression on their 12 lead ECG.

Let's consider what the information tells us. What does ST elevation, or depression, indicate?

+5 for presenting a topic that is frequently glossed over.

[Just Plain Ruff]

http://stroke.ahajournals.org/cgi/content/abstract/27/4/737

good article - study done on dogs but relates the changes you are talking about.

I was always told that someone with a acute bleed can present with some pretty nasty cardiac rhythms due to the pressing down of the brain on the brainstem. I was also taught that getting rid of the bleed was key to getting rid of the cardiac events but it sounds like the more I read, the more pressing(no pun intended) these problems sometimes do not go away after the bleed is fixed. They stay around.

This is why it is imperitive that you monitor a patient in this condition for cardaic abnormalities even after the bleed has been fixed.

Another article I read says that many times the mortality due to cardiac events secondary to brain bleeds is pretty high. I'll have to re-find that article. (sorry no source on this one yet)

[zzyzx]

Yes, sorry, I meant V1 and V2. :roll:

I did have another patient a few months ago who had what turned out to be a massive intracranial bleed, and he also had a funky rhythm on the ECG. It looked like bigeminy, but it only lasted for a short while and he was back in a normal sinus rhythm or a sinus tach by the time we got him into the ambulance. This really through us off because we started thinking that the cause of his being unresponsive (with only a weak gag reflex) might be something cardiac, although that didn't make sense since his skins were flushed and his BP was within normal limits.

When the ER did a 12-lead, it showed that he was having an acute MI (the computer actually gave the alert). As it turned out though, this was misleading. Our patient turned out to be having a massive head bleed. He was pretty young, 40ish. After we'd dropped him off at the ER and I was doing my paperwork, he woke up and became fully alert and orient. The crappy thing about this call was that I, thinking that he must've just had a seizure and been postictal (though of course I'd never seen anyone postictal be totally unresponsive like this), told his wife that he would be totally okay and that he'd just had a seizure. It turns out that he was just having a lucid interval, and that soon after I left he became totally unresponsive again and that they found a massive bleed on the CT.