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Waking up from coronary bypass surgery and one eye does not move right
Shamir Haji1, Manoj K Mittal, Eelco F Wijdicks
1Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. Haji.Shamir@mayo.edu
Neurocritical Care
|January 6, 2012
Summary
Coronary artery bypass graft surgery can cause acute oculomotor nerve palsy. This pupil-sparing complication, linked to midbrain infarction, requires recognition in cardiac surgery patients.
Area of Science:
- Neurology
- Cardiology
- Ophthalmology
Background:
- Coronary artery bypass graft (CABG) surgery is associated with neurological complications.
- Acute oculomotor nerve palsy and pituitary apoplexy are known risks.
- These complications can manifest with extraocular muscle dysfunction and pupillary changes.
Observation:
- A 58-year-old male developed a pupil-sparing partial oculomotor palsy after CABG.
- Neurological exam showed isolated medial rectus and levator palpebrae superioris paresis.
- Magnetic resonance imaging confirmed acute midbrain infarction.
Findings:
- The patient presented with a specific pattern of oculomotor nerve palsy post-cardiac surgery.
- The absence of pupillary involvement was a key diagnostic feature.
- Midbrain infarction was identified as the cause of the palsy.
Implications:
- Pupil-sparing oculomotor nerve palsy is a recognized neurological complication of cardiac surgery.
- Recognizing this specific palsy aids in diagnosing stroke post-CABG.
- Pupillary sparing is crucial for differentiating etiologies of oculomotor nerve palsy.
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