Early Neurological Outcomes Following Cardiac Surgery

Introduction Cardiac surgery can impair cerebral autoregulation, leading to neurological complications like postoperative cognitive dysfunction and silent brain ischemia (SBI). [1] Case Presentation A 60-year-old male was admitted to LHUS Kaunas Clinics on 2023-02-06 for planned on-pump CABG surgery due to three-vessel coronary artery disease following a myocardial infarction one month ago. The patient was classified as ASA III, with a EuroSCORE of 2.2%. General endotracheal anesthesia was administered. The total duration of anesthesia was 5 h 50 min, while the surgery lasted for 4 h 25 min. Cardiopulmonary bypass lasted for 101 min, with the aortic cross-clamping occurring for 57 min. The single longest episode of cerebral autoregulation impairment lasted 3.3 min, with a total duration of impairment amounting to 84.23 min. 4 days after surgery, the patient reported numbness in their hands and tongue. Urgent CT and CTA showed no focal brain lesions. The neurologist diagnosed transient ischemic attack, symptoms resolved spontaneously. Despite that, after a few days, the patient became restless and disoriented and reported hallucinations. Since no active psychopathology was identified during the examination, there was insufficient evidence for delirium, and an unspecified disorder due to brain damage was diagnosed. Based on suspicion, this patient underwent an additional MRI. In the lower semilunar lobule of the right cerebellum, a wedge-shaped area with T2, DWI, and ADC hyperintense signal intensity is observed in the periphery, indicative of post-ischemic changes. The patient was treated as advised by specialists, leading to gradual symptom regression. The patient was discharged home after 18 days. Discussion SBIs after cardiac surgery pose risks of cognitive decline, dementia, and reduced quality of life. Key factors include autoregulation dysfunction, embolization, ischemia, and and systemic inflammation triggered by surgical manipulation. Improved neuroprotection and further research are needed. [2,3] Conclusions SBIs after cardiac surgery are significant and may impact long-term cognitive function, highlighting the need for improved detection, prevention, and management.