Evaluation of neurologic assessment and outcomes in cardiac surgical patients

It is well recognized that cardiac surgery with cardiopulmonary bypass can potentially induce a wide spectrum of central nervous system (CNS) sequelae. Our awareness of the prevalence of these CNS complications is dependent on the validity of the available diagnostic methods. Current assessment methods designed to detect both focal and diffuse cerebral ischemia include neurologic examination, imaging techniques, biochemical markers, neuropsychologic assessment, and patient perceived outcomes. These techniques vary in their sensitivity and specificity, as well as feasibility for use in everyday clinical practice. There are currently only limited standardized methodologic guidelines for the assessment of CNS complications after cardiac surgery, which has resulted in considerable interstudy variability in the identification and reporting of outcomes. The application of clearly definable endpoints for reporting of CNS outcomes would be beneficial. The wealth of available data suggests that the incidence of overt CNS injury such as stroke has declined since the 1980s and is now approximately 2%, whereas evidence suggests that up to one third of cardiac surgery patients experience postoperative cognitive deficits. One of the clear strengths of the current era is the recognition of CNS injury associated with cardiac surgery, and the quest to improve our understanding of these outcomes. The application of more uniform assessment and reporting practices is surely vital to the continued advancement of cardiac surgery.