HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Harrison, M. J. G. Search for Related Content PubMed PubMed Citation Articles by Harrison, M. J. G.

Ann Thorac Surg 1995;59:1356-1358
© 1995 The Society of Thoracic Surgeons

---

Articles

Neurologic complications of coronary artery bypass grafting: Diffuse or focal ischemia?

University College, London, United Kingdom

^* Address reprint requests to Mr Harrison, Middlesex Hospital, Mortimer St, London, United Kingdom WIN 8AA.

	Abstract

Top Abstract Footnotes References

 
The central nervous system complications arising during or shortly after coronary artery bypass grafting are due to cerebral ischemia associated with hypotension and to embolism. Hemodynamic compromise produces a spectrum of disturbance of consciousness and mentation ranging from brain death and coma through the chronic vegetative state to mild confusion. Watershed infarction may add to this picture focal deficits such as visual disorientation and cortical field defects or bibrachial weakness (the "man in a barrel" syndrome). Macroembolism accounts for most perioperative strokes and is related to cardiac arrhythmias, to intracardiac thrombus, and particularly to the severity and friable nature of any aortic atheroma. Microembolism can cause focal problems in the watershed territory but is normally responsible for diffuse changes as seen in the neuropsychologic sequelae of coronary artery bypass grafting. Coexistent carotid artery disease rarely contributes to the postoperative neurologic changes.

	Footnotes

Top Abstract Footnotes References

 
Presented at the Conference on CNS Dysfunction After Cardiac Surgery: Defining the Problem, Fort Lauderdale, FL, Dec 10–11, 1994.

	References

Top Abstract Footnotes References

 

1. Furlan AJ, Sila CA, Chimowitz MI, Jones SC. Neurologic complications related to cardiac surgery Neurol Clin 1992;10:145-166.[Medline]
2. Takahashi S, Higano S, Ishii K, et al. Hypoxic brain damage: cortical laminar necrosis and delayed changes in white matter at sequential MR imaging Radiology 1993;189:449-456.[Abstract/Free Full Text]
3. Howard R, Trend P, Ross Russell RW. Clinical features of ischaemia in cerebral arterial border zones after periods of reduced cerebral blood flow Arch Neurol 1987;44:934-940.[Medline]
4. Amarenco P, Kase CS, Rosengart A, et al. Very small (border zone) cerebellar infarcts Brain 1993;116:161-186.[Abstract/Free Full Text]
5. Creswell LL, Schuessler RB, Rosenbloom M, Cox JL. Hazards of postoperative atrial arrhythmias Ann Thorac Surg 1993;56:539-549.[Abstract/Free Full Text]
6. Hartman RB, Harrison EE, Pupello DF, Vijayanagar R, Sbar SS. Characteristics of left ventricular thrombus resulting in perioperative embolism J Thorac Cardiovasc Surg 1983;86:706-709.[Abstract]
7. Hosoda Y, Watanabe M, Hirooka Y, et al. Significance of atherosclerotic changes of the ascending aorta during coronary artery bypass surgery with intraoperative detection by echography J Cardiovasc Surg (Torino) 1991;32:301-306.[Medline]
8. Pollanen MS, Deck JHN. Directed embolization is an alternate cause of cerebral watershed infarction Arch Pathol Lab Med 1989;113:1139-1141.[Medline]
9. Pugsley W, Klinger L, Paschalis C, Treasure T, Harrison M, Newman S. The impact of microemboli during cardiopulmonary bypass on neuropsychological functioning Stroke 1994;25:1393-1399.[Abstract/Free Full Text]
10. Rorick MB, Furlan AJ. Risk of cardiac surgery in patients with prior stroke Neurology 1990;40:835-837.[Abstract/Free Full Text]
11. Symon L, Crockard HA, Dorsch NWC, et al. Local cerebral blood flow and vascular reactivity in a chronic stable stroke in baboons Stroke 1975;6:482-492.[Abstract/Free Full Text]
12. Harrison MJG. The potential role of carotid artery diseaseIn: Smith P, Taylor K, editors. Cardiac surgery and the brain. Berlin: Edward Arnold; 1993. pp. 17-23.
13. Spencer MP, Thomas GI, Nicholls SC, Sauvage LR. Detection of middle cerebral emboli during carotid endarterectomy using transcranial Doppler ultrasonography Stroke 1990;21:415-423.[Abstract/Free Full Text]
14. Markus HS, Harrison MJG. Estimation of cerebrovascular reactivity using transcranial Doppler, including the use of breath-holding as the vasodilatory stimulus Stroke 1992;23:668-673.[Abstract/Free Full Text]

This article has been cited by other articles:

				D. Leys, C. Cordonnier, and V. Caso Chapter 65 Stroke The ESC Textbook of Acute and Intensive Cardiac Care, December 1, 2010; 1(1): med-9780199584314-chapter - med-9780199584314-chapter. [Abstract] [Full Text] [PDF]

				N. Stroobant, G. van Nooten, D. De Bacquer, Y. Van Belleghem, and G. Vingerhoets Neuropsychological functioning 3-5 years after coronary artery bypass grafting: does the pump make a difference? Eur J Cardiothorac Surg, August 1, 2008; 34(2): 396 - 401. [Abstract] [Full Text] [PDF]

				G. I. Tagarakis, F. Tsolaki-Tagaraki, M. Tsolaki, A. Diegeler, N. B. Tsilimingas, and A. Papassotiropoulos The Role of Apolipoprotein E in Cognitive Decline and Delirium after Bypass Heart Operations American Journal of Alzheimer's Disease and Other Dementias, July 1, 2007; 22(3): 223 - 228. [Abstract] [PDF]

				J.-C. Tardif, M. Carrier, D. E. Kandzari, R. Emery, R. Cote, T. Heinonen, M. Zettler, V. Hasselblad, M.-C. Guertin, R. A. Harrington, et al. Effects of pyridoxal-5'-phosphate (MC-1) in patients undergoing high-risk coronary artery bypass surgery: Results of the MEND-CABG randomized study J. Thorac. Cardiovasc. Surg., June 1, 2007; 133(6): 1604 - 1611. [Abstract] [Full Text] [PDF]

				S. Bar-Yosef, M. Anders, G. B. Mackensen, L. K. Ti, J. P. Mathew, B. Phillips-Bute, R. H. Messier, H. P. Grocott, and the Neurological Outcome Research Group and CARE I Aortic Atheroma Burden and Cognitive Dysfunction After Coronary Artery Bypass Graft Surgery Ann. Thorac. Surg., November 1, 2004; 78(5): 1556 - 1562. [Abstract] [Full Text] [PDF]

				D. S. Likosky, B. J. Leavitt, C. A. S. Marrin, D. J. Malenka, A. G. Reeves, R. M. Weintraub, L. R. Caplan, Y. R. Baribeau, D. C. Charlesworth, C. S. Ross, et al. Intra- and postoperative predictors of stroke after coronary artery bypass grafting Ann. Thorac. Surg., August 1, 2003; 76(2): 428 - 434. [Abstract] [Full Text] [PDF]

				D. C. Charlesworth, D. S. Likosky, C. A. S. Marrin, C. T. Maloney, H. B. Quinton, J. R. Morton, B. J. Leavitt, R. A. Clough, and G. T. O'Connor Development and validation of a prediction model for strokes after coronary artery bypass grafting Ann. Thorac. Surg., August 1, 2003; 76(2): 436 - 443. [Abstract] [Full Text] [PDF]

				N. Stroobant, G. Van Nooten, Y. V. Belleghem, and G. Vingerhoets Short-term and long-term neurocognitive outcome in on-pump versus off-pump CABG Eur J Cardiothorac Surg, October 1, 2002; 22(4): 559 - 564. [Abstract] [Full Text] [PDF]

				R. Ascione, B. C. Reeves, M. H. Chamberlain, A. K. Ghosh, K. H.H. Lim, and G. D. Angelini Predictors of stroke in the modern era of coronary artery bypass grafting: a case control study Ann. Thorac. Surg., August 1, 2002; 74(2): 474 - 480. [Abstract] [Full Text] [PDF]

				E. Symes, P. Maruff, A. Ajani, and J. Currie Issues Associated with the Identification of Cognitive Change Following Coronary Artery Bypass Grafting Australian and New Zealand Journal of Psychiatry, October 1, 2000; 34(5): 770 - 784. [Abstract] [Full Text] [PDF]

				A. Diegeler, R. Hirsch, F. Schneider, L.-O. Schilling, V. Falk, T. Rauch, and F. W. Mohr Neuromonitoring and neurocognitive outcome in off-pump versus conventional coronary bypass operation Ann. Thorac. Surg., April 1, 2000; 69(4): 1162 - 1166. [Abstract] [Full Text] [PDF]

				D. P. B. Janssen, L. Noyez, J. A. M. van Druten, S. H. Skotnicki, and L. K. Lacquet Predictors of neurological morbidity after coronary artery bypass surgery Eur J Cardiothorac Surg, February 1, 1999; 15(2): 166 - 172. [Abstract] [Full Text] [PDF]

				L. Birincioglu, K. Arda, H. Bardakci, K. Ozberk, M. Bayazlt, T. Cumhur, O. Tasdemir, and K. Bayazit Carotid Disease in Patients Scheduled for Coronary Artery Bypass: Analysis of 678 Patients Angiology, January 1, 1999; 50(1): 9 - 19. [Abstract] [PDF]

				L. Noyez, D. P. B. Janssen, J. A. M. van Druten, S. H. Skotnicki, and L. K. Lacquet Coronary bypass surgery: what is changing?: Analysis of 3834 patients undergoing primary isolated myocardial revascularization Eur J Cardiothorac Surg, April 1, 1998; 13(4): 365 - 369. [Abstract] [Full Text] [PDF]

				A. Jacobs, M. Neveling, M. Horst, M. Ghaemi, J. Kessler, H. Eichstaedt, J. Rudolf, P. Model, H. Bonner, E. R. de Vivie, et al. Alterations of Neuropsychological Function and Cerebral Glucose Metabolism After Cardiac Surgery Are Not Related Only to Intraoperative Microembolic Events Stroke, March 1, 1998; 29(3): 660 - 667. [Abstract] [Full Text] [PDF]

				J S Davies, M F Scanlon, and P E Belchetz Lesson of the week: Hypopituitarism after coronary artery bypass grafting • Commentary: Hypoadrenalism should also be considered in cases of persistent hyponatraemia BMJ, February 28, 1998; 316(7132): 682 - 682. [Full Text]

This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Harrison, M. J. G. Search for Related Content PubMed PubMed Citation Articles by Harrison, M. J. G.