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Posterior distribution of infarcts in strokes related to cardiac operations
D Barbut1, D Grassineau, E Lis
1Department of Neurology, Cornell University Medical College, New York, New York, USA.
Insights
Post-cardiac surgery strokes are often multiple and affect the posterior brain, suggesting atheroembolization. Delayed strokes may stem from cardiogenic embolism, impacting stroke mechanisms after heart surgery.
Area of Science:
- Neurology
- Cardiology
- Radiology
Background:
- Stroke is a significant complication following cardiac surgery.
- Embolic events are the primary cause of stroke, though hypoperfusion can contribute.
- This study investigates radiologic findings to confirm embolic stroke mechanisms.
Purpose of the Study:
- To determine if radiologic appearances of stroke after cardiac surgery are consistent with an embolic cause.
- To differentiate stroke mechanisms based on timing and imaging characteristics.
Main Methods:
- Retrospective review of computed tomographic (CT) scans and medical records for 24 post-cardiac surgery patients with stroke.
- Categorization of patients into two groups based on stroke onset: within 24 hours (group 1) and beyond 24 hours (group 2).
Main Results:
- Early strokes (group 1) were frequently multiple (79%) and involved posterior brain regions, including bilateral cerebellar and posterior cerebral artery infarcts.
- Atheromatous plaque in the aorta/arch was found in 56% of evaluated group 1 patients.
- Delayed strokes (group 2) were associated with cardiac arrhythmias in 60% of cases.
Conclusions:
- Perioperative strokes after cardiac surgery typically present as multiple infarcts in posterior brain regions, indicative of atheroembolization.
- Delayed strokes may be linked to cardiogenic embolism, highlighting different embolic sources.
- Radiologic findings support embolic mechanisms as the predominant cause of stroke in this population.
Background:
Stroke complicates cardiac surgical procedures in a substantial number of patients. The mechanism of stroke is predominantly embolic, although hypoperfusion may play a role. The aim of this study was to determine whether radiologic appearances in this population were consistent with an embolic cause.
Methods:
We reviewed computed tomographic scans and medical records in 24 patients who suffered stroke after cardiac operation. Stroke was evident at 24 hours in 19 patients (79%). Infarcts were multiple in 16 and single in 3 patients (group 1). The remaining 5 patients suffered stroke beyond 24 hours and had single infarcts on computed tomographic scan (group 2).
Results:
In group 1, 15 patients (79%) had bilateral cerebellar infarcts, 4 (74%) had posterior cerebral artery infarcts, 10 (53%) had posterior watershed infarcts, and 11 patients (58%) had middle cerebral artery branch infarcts. The mean number of vascular territories involved was 5.1 (range, 1 to 10). Mobile atheromatous plaque was present in the ascending aorta or arch in 5 of 9 patients (56%) in group 1. In group 2, stroke occurred in close association with atrial or ventricular fibrillation in 3 of 5 patients (60%).
Conclusions:
In patients with radiologic evidence of infarction, perioperative strokes after cardiac operation are typically multiple, and involve the posterior parts of the brain, consistent with atheroembolization. Delayed strokes may be attributable to cardiogenic embolism.