Right Sylvian fissure subarachnoid hemorrhage has electrocardiographic consequences

Background and Purpose-Abnormal ECG changes are frequently observed in pati ents with subarachnoid hemorrhage (SAH). Recently, evidence has been obtain ed that right insular cortex mediates sympathetic cardiovascular effects. W e therefore assessed the laterality and location of SAH dominance in induci ng cardiovascular changes as measured by ECG, blood pressure, and heart rat e. Methods-After exclusion of 11 SAH patients who died within 1 month after on set, we studied 118 consecutive patients. Data were obtained from records o f blood pressure and pulse on admission. Abnormal ECG changes were determin ed from ECGs on admission and almost 1 month later. From brain CT scans per formed immediately after admission, the amount of SAH in each of the 8 cist erns and fissures was measured semiquantitatively. Results-Twenty-six patients had abnormal changes on admission ECG, while 92 patients did not. Systolic blood pressure, diastolic blood pressure, and t he amounts of blood in the left ambient cistern, left suprasellar cistern, quadrigeminal cistern, right ambient cistern, right suprasellar cistern, ri ght sylvian fissure, and the set of all cisterns were significantly greater in the group with ECG change than in the group without ECG change. Multiva riate logistic regression analysis with stepwise method indicated that syst olic blood pressure > 160 mm Hg (P=0.0006) and the amounts of SAH in the qu adrigeminal cistern (P=0.022) and right sylvian fissure (P=0.0019) were ind ependently associated with abnormal ECG change. Conclusions-Cardiac consequences are possible inpatients with massive right sylvian fissure SAH or when systolic blood pressure is > 160 mm Hg.