In order to assess the relationship of electrocardiographic (ECG) changes in acute cerebrovascular accidents (CVA) to the locations of the cerebral lesions, ECG records and brain computerized tomographic (CT) scans which were taken within 48 hours of CVA onset were examined in 39 patients without heart disease and/or treatment with cardiovascular drugs. The ECG was normal in 25% (3/12) of basal ganglial CVA, 22% (2/9) of frontal CVA and 36% (4/11) of temporo-parietal CVA. Nonspecific ST-T changes occurred in basal ganglial CVA (25%), frontal CVA (22%), temporo-parietal CVA (18%) and in the other categories of CVA locations. Corrected QT interval (QTc) elongation was observed not only in frontal (22%), but also in basal ganglial CVA (25%), temporo-parietal CVA (36%) and cerebellar CVA (50%). There were no ECG changes specific to a particular CVA location. These findings suggest that widely distributed neurons and pathways within the central nervous system may influence ECG.