This is one of the more difficult EKGs I've found. This is seen in a young patient with no past medical history presenting with vertigo. Her electrolytes were normal. Cardiac enzymes were normal. Cardiac cath was normal.
Challenge: What do you see? Where's the lesion?
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This EKG demonstrates marked QT-U prolongation; it is as if a giant U is appended to the T wave, inverted in the inferolateral leads. This is actually a manifestation of a cerebrovascular accident (usually a subarachnoid hemorrhage, but intracranial bleeds are possible as well). The mechanism is uncertain.
Sources: UpToDate; EKG Wave-Maven.
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