Waking up from coronary bypass surgery and one eye does not move right.
BACKGROUND
Complications of coronary artery bypass graft surgery (CABG) include acute oculomotor nerve palsy secondary to ischemic stroke and pituitary apoplexy. These can present with impairment of extraocular muscle function as well as involvement or sparing of the pupil.


METHODS
We report the case of a 58-year-old male admitted for elective CABG surgery for severe coronary artery disease and found to have a pupil-sparing partial oculomotor palsy post-procedure. Neurological examination revealed left pupil-sparing isolated medial rectus and levator palpebrae superioris paresis. Magnetic resonance imaging demonstrated acute midbrain infarction.


CONCLUSIONS
Acute pupil-sparing partial oculomotor nerve palsy should be recognized as a neurological complication of cardiac surgery. Pupillary involvement can be helpful in identifying the underlying etiology.
Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. Haji.Shamir@mayo.edu
Shamir
S
Haji
Manoj K
MK
Mittal
Eelco F
EF
Wijdicks
D000208:Acute Disease; D020520:Brain Infarction / Q000209:etiology* / Q000473:pathology; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003422:Critical Care; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015840:Oculomotor Nerve Diseases / Q000209:etiology* / Q000473:pathology; D011183:Postoperative Complications / Q000209:etiology* / Q000473:pathology