Neurogenic ST depression in stroke

Background: Stroke is occasionally associated with ECG repolarization chang es including ST depression. Recent evidence suggests a neurogenic contribut ion to these abnormalities in stroke patients. Animal studies implicate the insular cortex in cardiovascular control. We describe a patient with a lef t insular infarct and without cardiac or coronary artery disease, who devel oped ST depression indicating a neurogenic etiology. Case description: A 48 year-old female, with no risk factors for stroke, developed sudden express ive aphasia. MRI brain showed an infarct in the left insular cortex. Twenty -four hour Welter monitoring on the third day revealed transient ST depress ion more than 1.5 mm, which was not reproducible on subsequent monitoring. Transesophageal echo-cardiography (TEE) was normal. She had no cardiac symp toms and serial ECGs, cardiac enzymes (CKMB) and adenosine-thallium scan we re normal. To-date, there had been no cardiac events like congestive heart failure or myocardial ischemia. Conclusion: These findings suggest neurogen ic ST depression is related to the left insular infarct in view of the norm al adenosine-thallium scan, non-reproducibility and evanescence of the ST s egment changes and lack of associated cardiac symptoms. When neurogenic ST depression is combined with underlying coronary artery disease, it may adve rsely influence cardiac outcome after stroke. (C) 1999 Elsevier Science B.V . All rights reserved.