A common ECG finding with an uncommon explanation.

We report a 78-year-old asymptomatic woman with no cardiac history and unremarkable cardiac evaluation, referred for a pre-surgical ECG showing diffuse T-wave inversion. Following ventriculoperitoneal shunting for chronic normal-pressure hydrocephalus (NPH), her ECG gradually normalized, suggesting a reversible neurocardiac effect. This case highlights a not well documented association between chronic NPH and T-wave inversions, possibly mediated by autonomic dysregulation, and underscores the importance of considering extracardiac neurologic disorders in the ECG differential diagnosis.