異常な心電図所見を追求しえたくも膜下出血の1例

抄録

A case of spontaneous subarachnoid hemorrhage presenting abnormal electrocardiogram could be summed up in the following details.
Three days after the hemorrhage the tracing of the electrocardiogram consists of prolongation QT interval, wide giant upright T waves and prominent U waves.
But 7 days after the hemorrhage, instead of these findings, there are abnormal Q spikes and elevation of ST-T segments in Lead II, III and aV_F just like posterior myocardial infarction.
After that these infarction-like-findings gradually diminished. On the 18th day disturbance of atrioventricular conduction are present, but 1 and 1/2 month after the hemorrhage these alterations cannot be observed.
There are no special electrolyte changes, and no clinical and no other laboratory findings indicating coronary artery disease.
After the report of Levine in 1953; Burch, Wasserman, Ozawa, Takahashi, Fentz and some others reported the same changes in patients with cerebral vascular accidents and tumors of the central nervous system, and in patients operated on the basic area of the brain.
There are some experiments to investigate these phenomenon. In 1958 Roganti observed the changes of T waves and the prolongation of QT interval, when he injected some inactive liquid into the spinal cavity of animals. It showed that elevation of cerebrospinal pressure may be one of the factors in electrocardiographic abnormalities.
Recently it was discussed that there was an integrating center of the cardiac function in the central nervous system. Levine, Pool and Takeuchi thought it was orbital surface of anterior lobe and Fentz concentrated on area 13 (orbital surface of anterior lobe) and area 24. Cropp and Manning explained that these areas were cortical representation of vagus. These belong to limbic system.
These findings were observed not only in cerebrovascular accidents but by trauma and tumor. We believe electrocardiogram should be utilized even for deciding diagnosis and prognosis of cerebral disorders.
But the mechanisms of these abnormalities are still in early stage of the research at present and it will be found a big key-point for clearing up the cortical localization of all visceral function, when a better and more dependable mechanism is realized.