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Brain Damage After Coronary Artery Bypass Grafting

Postoperative impairment in neuropsychological test performance is linked with a transient metabolic neuronal disturbance.

However, although focal ischemic lesions after coronary artery bypass grafting (CABG) are more frequent than is the apparent neurological complication rate, the lesions are not related to the diffuse postoperative encephalopathy, suggests a study in Germany.

The link between CABG and postoperative risk for focal neurological deficits and neuropsychological impairment prompted these researchers to examine post-CABG brain damage using diffusion-weighted magnetic resonance imaging and ¹HH-magnetic resonance spectroscopy (MRS).

Martin Bendszus, MD, and colleagues from the University of Wurzburg, Wurzburg, administered neurological and neuropsychological examinations to 35 consecutive patients prior to and after elective CABG.

Researchers applied the magnetic resonance protocol before and a mean of three days after surgery. The imaging included a diffusion-weighted sequence and single-voxel MRS measurements in the frontal lobes.

Post-surgery, no new focal neurological deficit was revealed in any of the patients.

Diffusion-weighted magnetic resonance imaging demonstrated new ischemic lesions in nine (26 percent) of the patients. However, presence of an ischemic lesion was not related to impaired postoperative test performance.

The apparent diffusion coefficient values in the cerebellum and the centrum semiovale showed a post-surgery increase consistent with vasogenic oedema.

After surgery, MRS revealed a significant decrease in the metabolite ratio of N-acetylaspartate-creatine. The degree of this decrease was closely linked with the extent of post-surgery deterioration in neuropsychological test performance.

A normalization of the N-acetylaspartate-creatine ratio revealed on follow-up MRS scan accompanied the recovery in psychological test performance.
Arch Neurol. 2002;59:1090-1095. "Brain Damage After Coronary Artery Bypass Grafting"

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