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Bendszus M, Reents W, Franke D, et al. Brain Damage After Coronary Artery Bypass Grafting. Arch Neurol. 2002;59(7):1090–1095. doi:https://doi.org/10.1001/archneur.59.7.1090
Coronary artery bypass grafting (CABG) is associated with a risk for focal neurological deficits and neuropsychological impairment postoperatively.
To examine the brain damage after CABG using diffusion-weighted magnetic resonance imaging and 1H-magnetic resonance spectroscopy (MRS) and to correlate the results with neurological and neuropsychological findings.
Patients and Methods
Thirty-five consecutive patients undergoing elective CABG were included. Patients underwent a neurological and neuropsychological examination before and after CABG. The magnetic resonance protocol was applied before and after (mean, 3 days) surgery and included a diffusion-weighted sequence and single-voxel MRS measurements in the frontal lobes.
None of the patients revealed a new focal neurological deficit after surgery. Diffusion-weighted magnetic resonance imaging demonstrated new ischemic lesions in 9 (26%) of the patients. The presence of an ischemic lesion was not related to impaired postoperative test performance (P>.50). The apparent diffusion coefficient values in the cerebellum and the centrum semiovale exhibited an increase after surgery (P<.01), consistent with vasogenic edema. Following surgery, MRS revealed a significant decrease in the metabolite ratio of N-acetylaspartate–creatine (mean ± SD, 1.69 ± 0.20 vs 1.52 ± 0.19; P<.001). The extent of deterioration in neuropsychological test performance after surgery was closely related to the degree of the N-acetylaspartate–creatine ratio decrease (P<.01). A follow-up MRS scan revealed a normalization of the N-acetylaspartate–creatine ratio, which accompanied the recovery in psychological test performance.
Postoperative impairment in neuropsychological test performance is associated with a transient metabolic neuronal disturbance. Focal ischemic lesions after CABG are more frequent than the apparent neurological complication rate; however, they are not related to the diffuse postoperative encephalopathy.
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