title: Neurologic outcomes of preoperative acute silent cerebral infarction in patients with cardiac surgery.
abstract: BACKGROUND
  Acute cerebral infarction is a major risk factor for postoperative neurologic complications in cardiac surgery. However, the outcomes associated with acute silent cerebral infarction (ASCI) have not been not well established. Few studies have reported the postoperative outcomes of these patients in light of preoperative Diffusion-weighted magnetic resonance imaging (DWI). We studied the postoperative neurologic outcomes of patients with preoperative ASCI detected by DWI.
  
  
  METHODS
  We retrospectively studied 32 patients with preoperative ASCI detected by DWI. None of the patients had preoperative neurologic symptoms. The mean age at operation was 68.8±9.5 years. Five patients had previous histories of stroke. Four patients had been diagnosed with infective endocarditis. Single cerebral infarct lesions were detected in 16 patients, double lesions in 13, and multiple lesions (>5) in three. The median size of the infarct lesions was 4 mm (range, 2 to 25 mm). The operations of three of the 32 patients were delayed pending follow-up DWI studies.
  
  
  RESULTS
  There were two in-hospital mortalities. Neurologic complications also occurred in two patients. One patient developed extensive cerebral infarction unrelated to preoperative infarct lesions. One patient showed sustained delirium over one week but recovered completely without any neurologic deficits. In two patients, postoperative DWI confirmed that no significant changes had occurred in the lesions.
  
  
  CONCLUSIONS
  Patients with preoperative ASCI showed excellent postoperative neurologic outcomes. Preoperative ASCI was not a risk factor for postoperative neurologic deterioration.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Saint Carollo General Hospital.
authors.forename: Hyung Tae
authors.initials: HT
authors.lastname: Sim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Saint Carollo General Hospital.
authors.forename: Sung Ryong
authors.initials: SR
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Saint Carollo General Hospital.
authors.forename: Min Sun
authors.initials: MS
authors.lastname: Beom
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Saint Carollo General Hospital.
authors.forename: Ji Wook
authors.initials: JW
authors.lastname: Chang
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Saint Carollo General Hospital.
authors.forename: Na Rae
authors.initials: NR
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Saint Carollo General Hospital.
authors.forename: Mi Hee
authors.initials: MH
authors.lastname: Jang
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Saint Carollo General Hospital.
authors.forename: Sang Wan
authors.initials: SW
authors.lastname: Ryu
keywords: Cerebral infarction; Neurologic outcome; Thoracic surgery