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Ann Thorac Surg 2008;86:634-637. doi:10.1016/j.athoracsur.2008.02.021
© 2008 The Society of Thoracic Surgeons
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Thoralf Sundt
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Case Reports

Reversible Unilateral Brain Edema Presenting With Major Neurologic Deficit After Valve Repair

Eelco F.M. Wijdicks, MD*, Norbert Campeau, MD, Thoralf Sundt, MD

Department of Neurology, and Division of Critical Care Neurology, Diagnostic Radiology, Cardiovascular Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota

Accepted for publication February 1, 2008.

* Address correspondence to Dr Wijdicks, Mayo Clinic College of Medicine, Department of Neurology and Division of Critical Care Neurology, 200 First St SW, Rochester, MN 55905 (Email: wijde{at}mayo.edu).

Brain edema after cardiac surgery is unusual and often asymptomatic. We encountered a 34-year-old man who had postoperative left flaccid hemiplegia and anosognosia after undergoing composite root replacement and closure of a patent foramen ovale. Computed tomographic and magnetic resonance imaging (MRI) scans showed profound white matter changes indicative of brain edema predominantly in the right hemisphere. His symptoms resolved spontaneously within 3 days with resolution of MRI abnormality. No evidence of cerebral infarction was documented on diffusion-weighted imaging and apparent diffusion coefficient mapping, or on the follow-up MRI obtained 25 days after presentation. The cause for the unilateral brain edema is unknown, but the patient's clinical course and imaging are supportive for a variant of a hyperperfusion syndrome or reversible encephalopathy. The outcome was excellent.






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