Neurologic Complications in the Immediate Postoperative Period After Cardiac Surgery. Role of Brain Magnetic Resonance Imaging
| Autor: | Federico Ballenilla, Narciso Perales Rodríguez de Viguri, Ana Ramos-González, José L. Pérez-Vela, Almudena Escribá-Bárcena, Emilio Renes-Carreño, Luis F. Lopez-Almodovar, Juan J. Rufilanchas-Sánchez, Mercedes Rubio-Regidor |
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| Rok vydání: | 2005 |
| Předmět: |
Adult
Male Brain Death medicine.medical_specialty Encephalopathy Infarction Fluid-attenuated inversion recovery Cohort Studies Postoperative Complications Seizures medicine Humans Cardiac Surgical Procedures Stroke Aged Aged 80 and over Brain Diseases business.industry Incidence (epidemiology) Brain General Medicine Middle Aged Prognosis medicine.disease Magnetic Resonance Imaging Hyperintensity Cardiac surgery Surgery Female Radiology Tomography X-Ray Computed business Intracranial Hemorrhages Cohort study |
| Zdroj: | Revista Española de Cardiología (English Edition). 58:1014-1021 |
| ISSN: | 1885-5857 |
| DOI: | 10.1016/s1885-5857(06)60433-7 |
| Popis: | Introduction and objectives Neurologic complications still cause significant morbidity and mortality in the immediate postoperative period following cardiac surgery. Our understanding of the pathogenesis, prevention, and management of these lesions is constantly developing. Matherial and method We describe neurologic complications and their course in a cardiac surgery cohort and analyze the value of brain magnetic resonance imaging (MRI), using T 1 -weighted, T 2 -weighted, and FLAIR sequences, in patients with postoperative stroke or en-cephalopathy in whom CT scanning revealed no abnormalities explaining their clinical condition. Results In 688 patients studied postoperatively, we observed 57 neurologic complications (8.3%): 25 strokes, 24 encephalopathies, 5 seizure disorders, 2 brain deaths, and 1 intracranial hemorrhage. Initial CT scanning failed to show significant findings in 70%. 18 patients underwent brain MRI. In all but 1 of the 11 with stroke, MRI showed areas of acute or subacute infarction (i.e., hyperintensity in FLAIR or T 2 -weighted sequences) in different locations, mainly in a watershed distribution. In 3 of the 4 patients with mild-to-moderate encephalopathy, MRI showed lesions similar to those previously described for stroke. In the remaining 3 patients, who had severe encephalopathy, MRI showed diffuse cortical necrosis. Conclusions The incidence of neurologic complications in the postoperative period following cardiac surgery is significant. In a high percentage of patients, brain CT scanning may not show pathologic findings. In selected patients, MRI could help identify areas of infarction not detected by CT. These images could improve clinicians' understanding of the pathogenic, pathophysiologic, clinical, and prognostic characteristics of such neurologic complications. |
| Databáze: | OpenAIRE |
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