| Alterations of neuropsychological function and cerebral glucose metabolism after cardiac surgery are not related only to intraoperative microembolic events. | |
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MedLine Citation:
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PMID: 9506609 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND AND PURPOSE: High-intensity transient signals (HITS) during cardiac surgery are capable of causing encephalopathy and cognitive deficits. This study was undertaken to determine whether intraoperative HITS cause alterations of neuropsychological function (NPF) and/or cerebral glucose metabolism (CMRGlc), even in a low-risk patient group, and whether induced changes are interrelated. METHODS: Eighteen patients without signs of cerebrovascular disease underwent elective coronary artery bypass grafting (CABG), and two of these additionally underwent valve replacement in normothermia. Intraoperatively, HITS were recorded by means of transcranial Doppler ultrasonography (TCD). Perioperatively, NPF and CMRGlc were assessed using a standardized complex test battery and positron emission tomography with 18F-2-fluoro-2-deoxy-D-glucose (FDG-PET), respectively. RESULTS: Intraoperatively, the number of HITS ranged from 90 to 1710 per patient and hemisphere, more on the right side than on the left (P<.05). HITS occurred primarily during cardiopulmonary bypass (71.3%) and, to a lesser extent, during aortic manipulation (22.2%). Changes in global and regional CMRGlc between first (one day preoperatively) and second (8 to 12 days postoperatively) FDG-PET scans were mild. No correlations were found between the number of HITS, age of patient, duration of cardiac ischemia or cardiopulmonary bypass and the changes in CMRGlc. In patients with recorded HITS and a postoperative decrease of regional CMRGlc (n=11), the maximal decrease of rCMR Glc in each hemisphere below the individual global change of CMRGlc correlated with the number of HITS (r= -0.46, P<.05). Limitations in NPF occurred 8 to 12 days postoperatively, resolved within 3 months, and were not found to be correlated to the absolute number of HITS or changes in CMRGlc. CONCLUSIONS: HITS during cardiac surgery can cause alterations of both NPF and CMRGlc, even in a low-risk patient group. However, the number of HITS and changes in NPF and CMRGlc are not necessarily interrelated, which indicates that (1) the location of brain damage related to HITS is more important for the development of NPF than is the absolute number of HITS, and (2) factors in addition to HITS might contribute to surgery-related brain damage. |
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Authors:
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A Jacobs; M Neveling; M Horst; M Ghaemi; J Kessler; H Eichstaedt; J Rudolf; P Model; H Bönner; E R de Vivie; W D Heiss |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Stroke; a journal of cerebral circulation Volume: 29 ISSN: 0039-2499 ISO Abbreviation: Stroke Publication Date: 1998 Mar |
Date Detail:
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Created Date: 1998-03-24 Completed Date: 1998-03-24 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 0235266 Medline TA: Stroke Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 660-7 Citation Subset: IM |
Affiliation:
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Department of Neurology, University of Cologne, and the Max-Planck Institute for Neurological Research, Germany. jacobs@helix.mgh.harvard.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Brain / blood supply*, metabolism Brain Diseases / diagnosis, etiology* Cerebrovascular Circulation* Cognition Coronary Artery Bypass / adverse effects* Glucose / metabolism* Humans Intracranial Embolism and Thrombosis / diagnosis* Memory Middle Aged Neuropsychological Tests Personality Ultrasonography, Doppler |
| Chemical | |
Reg. No./Substance:
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50-99-7/Glucose |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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