Cardiac Abnormalities in Patients with Acute Subdural Hemorrhage
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ORIGINAL ARTICLE
Cardiac Abnormalities in Patients with Acute Subdural Hemorrhage Katharina M. Busl • Mahesh Raju • Bichun Ouyang • Rajeev K. Garg • Richard E. Temes
Ó Springer Science+Business Media New York 2013
Abstract Background Although cardiac abnormalities are well described among patients with acute brain injury, they have not been investigated systematically for acute subdural hemorrhage (SDH). We sought to investigate the prevalence and characteristics of cardiac abnormalities in patients with SDH. Methods Consecutive adult patients admitted to Rush University Neurosciences Intensive Care Unit with a diagnosis of SDH were analyzed. Electrocardiograms (ECGs), obtained within 48 h of admission were reviewed. Myocardial injury, defined as troponin I elevation (>0.09 ng/ml) on admission was identified. Results One hundred and fourteen patients admitted with SDH between 1 January 2010 and 31 December 2011 were included. Mean age was 67.9 years (SD 16.6 years), 60 % were male. Comorbidities included hypertension (74 %), diabetes mellitus (31 %), cardiovascular disease (35 %), and cerebrovascular disease (25 %). The SDH was rightsided in 47 %, and the most common location was frontoparietal (43 %). SDH size was 14.4 ± 7.9 mm, with 4.6 ± 5.5 mm midline shift. One or more ECG abnormalities were found in 75 % of patients. Troponin was K. M. Busl (&) R. K. Garg R. E. Temes Section of Neurocritical Care, Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, POB Suite 1121, Chicago, IL 60612, USA e-mail: [email protected] M. Raju Section of Cardiology, Division of Internal Medicine, Rush University Medical Center, Chicago, IL 60612, USA B. Ouyang Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Chicago, IL 60612, USA
elevated in nine patients. Cardiac abnormalities were not associated with SDH characteristics. Classic neurogenic ECG findings were not encountered. Conclusions Although we found ECG abnormalities to be common in patients with SDH, they were not associated with SDH characteristics, and classic neurogenic findings were not observed. Myocardial injury was infrequent and not associated with SDH characteristics. While cardiac abnormalities in acute intracerebral injury often are attributed to neurocardiogenic causes, these are unlikely prominent mechanisms in SDH. Other medical causes need to be considered, as this will have important implications for management. Keywords Acute subdural hemorrhage Subdural hematoma ECG abnormalities Myocardial injury Neurocardiogenic injury
Introduction Cardiac dysfunction is well described following acute brain injury, such as ischemic stroke, aneurysmal subarachnoid hemorrhage (SAH), and intracranial hemorrhage (ICH) [1]. Important electrocardiogram (ECG) changes described include diffuse ST segment changes, T wave inversions (TWIs), QT prolongation as well as arrhythmias, pulmonary edema, and hypotension [2–7]. Large inverted T waves following a prolonged QT cor
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