Semin Neurol 2008; 28(5): 703-715
DOI: 10.1055/s-0028-1105973
© Thieme Medical Publishers

Neurological Complications of Cardiac Surgery

Rebecca F. Gottesman1 , Guy M. McKhann1 , Charles W. Hogue2
  • 1Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 2Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Further Information

Publication History

Publication Date:
29 December 2008 (online)


Neurological injury resulting from cardiac surgery has a range of manifestations from focal neurological deficit to encephalopathy or coma. As the safety of drug-eluting stents comes into question, more patients will likely undergo coronary artery bypass graft surgery. These projections, along with the growing proportions of elderly patients and those with comorbidities, portend the potential for rising rates of perioperative neurological complications. The risk for neurological injury may be determined by the type of procedure, by patient-specific characteristics, and by the extent of cerebral embolization and hypoperfusion during and after surgery. Changes in surgical techniques, including the use of off-pump surgery, have not decreased rates of brain injury from cardiac surgery. When appropriate, modern neuroimaging techniques should be used in postoperative patients to confirm diagnosis, to provide information on potential etiology, to direct appropriate therapy, and to help in prognostication. Management of postoperative medications and early use of rehabilitation services is a recommended strategy to optimize the recovery for individuals with neurological injury after cardiac surgery.


Rebecca F Gottesman, M.D. , Ph.D. 

Department of Neurology, The Johns Hopkins Hospital, 600 North Wolfe Street

Meyer 6-109, Baltimore, MD 21287