Cortical infarction following cardiosurgical procedures - air embolism as a probable cause.
BACKGROUND
Focal neurological deficits following cardiopulmonary bypass surgery are usually thought to be the result of embolic stroke. Computed tomography (CT) is sometimes negative although severe deficits persist.


OBJECTIVE
To describe a syndrome consisting of reduced postoperative vigilance, frequent epileptic seizures and focal neurological deficits in the presence of an apparently normal CT scan and often isolated cortical infarction on magnetic resonance imaging (MRI).


METHODS
We retrospectively collected data on all patients fulfilling the above-mentioned criteria, seen for neurological examination by the consultant between 2002 and 2006 in our heart center.


RESULTS
We found 39 patients, nearly all of whom had cortical hyperintense lesions on diffusion-weighted MRI in the right hemisphere with corresponding left-sided hemiparesis. Early seizures occurred in 31 patients. Clinical outcome was heterogeneous.


CONCLUSIONS
Predominance of right hemisphere involvement and lesion pattern in MRI make air embolism the most probable cause for this postoperative syndrome.
Department of Neurology, Median Clinic, Bad Oeynhausen, Germany. dr.harald.griese@t-online.de
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Koerfer
D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D020520:Brain Infarction / Q000209:etiology* / Q000473:pathology; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D002536:Cerebral Arteries / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging; D004453:Echoencephalography; D004618:Embolism, Air / Q000150:complications* / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology / Q000473:pathology; D014057:Tomography, X-Ray Computed; D014711:Vertebral Artery / Q000000981:diagnostic imaging