ABSTRACT
Background The ECG diagnosis of left ventricular hypertrophy (LVH) has been challenging for over a hundred years. ECG diagnosis of LVH has shown good specificity but lacks sensitivity. In addition, voltage-based criteria can be affected by multiple conditions such as obesity and chronic lung disease. Therefore, we sought to compare Romhilt-Estes (R-E) criteria with commonly used voltage-based criteria in presumptive ECG diagnosis of LVH. Methods This is a retrospective electronic medical record study from September 1, 2017, to September 1, 2018, of 499 consecutive ECGs from Boca Raton Regional Hospital. Different ECG criteria were used to identify the presence of LVH, including the Cornell criteria, modified Cornell criteria, Sokolow-Lyon criteria, and Romhilt-Estes criteria. The main study outcome was to compare the R-E criteria in presumptive ECG diagnosis of LVH to the voltage-based criteria (Cornell, modified Cornell, and Sokolow-Lyon). Results After analyzing the ECGs using the different ECG criteria, R-E criteria were positive with LVH present (score ≥ 5 points) in 162 patients. In contrast, Cornell criteria were positive in 42 patients (8.4%), modified Cornell criteria in 50 patients (10%), and Sokolow-Lyon criteria in 13 patients (2.6%). In addition, R-E criteria showed higher positivity of LVH diagnosis compared to the sum of three voltage-based criteria (32.7% versus 21% respectively, p<0.001). Conclusion We presume that R-E criteria can help better diagnose LVH by ECG compared to other commonly-used voltage-based criteria. However, further studies are needed using confirmatory imaging to confirm the accuracy of R-E criteria and compare it with other voltage based-criteria.
ABSTRACT
The artery of Percheron (AOP) is a variant of the paramedian thalamic vasculature that supplies blood to the medial aspect of the thalamus and the rostral midbrain. The presentation of an infarct in this territory varies widely and is often characterized by nonspecific neurological deficits, with altered mental status, decreased level of consciousness, and memory impairment being among the most common. AOP infarcts are often missed on initial computed tomography (CT) scan, and additional imaging is usually not done due to low suspicion for stroke in most cases. There have been an increasing number of reports of AOP infarction, illustrating the diversity of clinical presentations and the challenge this presents to clinicians in the acute setting. Lacking the classic signs of stroke, many of these patients experience a delay in recognition and treatment, with the majority of diagnoses occurring outside the tissue plasminogen activator (tPA) window. This case highlights the unusual presentation and diagnostic difficulty of a patient with an AOP infarct, and serves as a reminder to include thalamic pathology in patients presenting with vague neurological symptoms and no obvious signs of stroke.
