Via practica 3-4/2026

Cerebral T-waves: when the brain changes the ECG

The interaction between the central nervous system (CNS) and the cardiovascular system represents a significant pathophysiological phenomenon that has gained increasing attention in clinical medicine over recent decades. As early as the first half of the twentieth century, clinicians observed that intense neurological or emotional stimuli could induce unexpected changes in cardiac function. It has gradually become evident that injury to brain structures involved in autonomic regulation may lead to a wide spectrum of cardiac manifestations, ranging from arrhythmias to electrocardiographic repolarization abnormalities known as cerebral T waves, often accompanied by elevated troponin levels and mimicking acute coronary syndrome (ACS). Such neurocardiac manifestations have been described across a broad spectrum of CNS disorders, including stroke, subarachnoid hemorrhage (SAH), subdural hematoma, severe traumatic brain injury, epilepsy, and encephalitis. Particular attention should be paid to infections caused by neuroinvasive herpesviruses, which, due to their ability to establish lifelong persistence, latency, and reactivation, may affect brain regions responsible for autonomic regulation. This can result not only in severe neurological symptoms but also in pronounced neurocardiac manifestations. The clinical presentation may initially be subtle and may mimic common infectious or internal conditions, thereby significantly complicating the diagnostic process. The present case report illustrates the phenomenon of brain–heart interaction in a 48-year-old patient with herpetic encephalitis, in whom marked ECG repolarization abnormalities associated with troponin elevation were observed during the acute phase of the disease. This case highlights the diagnostic complexity of neurocardiac manifestations and emphasizes the importance of considering neuroinvasive viral infections even in atypical or initially subtle clinical presentations. Clinical vigilance and early diagnosis are crucial for patient outcomes, including in the outpatient practice of general practitioners.

Keywords: cerebral T-waves, herpetic encephalitis, neurocardiac manifestations