A 50 year old male with a history of uncontrolled hypertension is found unresponsive at

the side of the street and is brought to the emergency room.

His temperature is 37.0, blood pressure 190/100, heart rate 50, respiratory rate is 8. He
is unrepsonsive on physical exam. Heart and lung exams are normal. Laboratory studies
including electrolytes and troponin levels are all normal. His ECG is below.

1. Normal sinus rhythm

2. Marked T wave inversions

3. Prolonged QT interval

An old ECG from this patient is obtained and is below. What study (lab or
imaging) should be ordered next? What is your suspected diagnosis?

A CT scan of the brain is needed. His clinical picture and ECG findings are consistent with
an acute central nervous system abnormality. Patients with subarachnoid hemorrhages,
intracranial hemorrhages, and less commonly severe ischemic strokes have ECGs that
reveal deep, symmetric T wave inversions and QT prolongation. Less commonly, carotid
endarterectomy can result in this ECG pattern chronically.