Reversible unilateral brain edema presenting with major neurologic deficit after valve repair.
Brain edema after cardiac surgery is unusual and often asymptomatic. We encountered a 34-year-old man who had postoperative left flaccid hemiplegia and anosognosia after undergoing composite root replacement and closure of a patent foramen ovale. Computed tomographic and magnetic resonance imaging (MRI) scans showed profound white matter changes indicative of brain edema predominantly in the right hemisphere. His symptoms resolved spontaneously within 3 days with resolution of MRI abnormality. No evidence of cerebral infarction was documented on diffusion-weighted imaging and apparent diffusion coefficient mapping, or on the follow-up MRI obtained 25 days after presentation. The cause for the unilateral brain edema is unknown, but the patient's clinical course and imaging are supportive for a variant of a hyperperfusion syndrome or reversible encephalopathy. The outcome was excellent.
Wijdicks
Eelco F M
EF
Department of Neurology, Division of Critical Care Neurology, Diagnostic Radiology, Cardiovascular Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA. wijde@mayo.edu
Campeau
Norbert
N
Sundt
Thoralf
T
D000328:Adult; D001929:Brain Edema / Q000150:complications / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010291:Paresis / Q000209:etiology; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology