In 1954, Burch and co-workers identified a specific electrocardiographic pattern peculiar to certain patients with cerebrovascular accident (CVA).1 In the series of Burch et al, 14 of 17 patients with this pattern had an intracranial hemorrhage. Subsequently, other investigators found the same pattern in patients with nonvascular intracranial lesions. However, in all studies the pattern was most frequently observed in patients with intracranial hemorrhage.
The "CVA pattern" is characterized by wide T waves of large amplitude ("giant" T waves). These wide T waves are usually inverted in the standard limb and in the left precordial leads and upright in the right precordial leads. Sometimes, the wide T waves of large amplitude are upright in the three standard limb leads and in the leads V1 through V6. The QTc interval is usually prolonged by up to 60% above normal. In many cases, the wide T wave cannot