Cerebral T Waves in Aneurysmal Subarachnoid Hemorrhage: An Uncommon ECG Manifestation Mimicking Myocardial Ischaemia–A Case Report

Background Electrocardiographic (ECG) changes are frequently observed in patients with subarachnoid hemorrhage (SAH), including deep T-wave inversions, QT prolongation, and arrhythmias, often mimicking acute coronary syndromes (1–4). ‘Cerebral T waves’ are particularly characteristic but under-recognised in emergency neurology and cardiology practice. Case Summary: We report a case of a 65-year-old female presenting with sudden onset severe headache, vomiting, and loss of consciousness. ECG demonstrated deep, symmetric, inverted T-waves in precordial leads, raising concern for myocardial infarction. CT brain revealed diffuse subarachnoid hemorrhage due to ruptured anterior communicating artery aneurysm. Serial cardiac enzymes were normal. Neurogenic stunned myocardium was suspected. The patient was taken for coiling procedure unfortunately she did not survive. Conclusions This case highlights the importance of recognising cerebral T waves as a neurogenic phenomenon rather than a primary cardiac pathology, preventing unnecessary thrombolysis or antiplatelet therapy. Awareness of ECG changes in SAH is critical for neurologists and emergency physicians.