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Departments of Neurology,
Psychosomatic Medicine and Surgery, Rikshospitalet, The National
Hospital, University of Oslo, N 0027, Norway
Correspondence to: Dr SK Brækken, Department of Neurology, Ullevål Hospital, 0407 Oslo, Norway. Telephone 0047 22118650; fax 0047 23015949.
Received 5 November 1997 and in revised form 2 March 1998;
Accepted 19 March 1998
OBJECTIVES
To examine the association between
intraoperative cerebral microembolic signals (MES) and postoperative
neuropsychological deficit in patients with valve replacement (VR) and
patients with coronary artery bypass grafting (CABG).
METHODSNeuropsychological examination (10 tests)
was performed 1-2 days before and 2 months after surgery (VR (n=26)
and CABG (n=14)). The intraoperative number of cerebral MES were
monitored from the right middle cerebral artery using transcranial Doppler.
RESULTSA higher number of cerebral MES were
detected in VR patients with neurological deficit (6/26) compared with
those without deficit (20/26) (MES median number 2083 v
645, p=0.04). No such difference was found in patients with CABG (2/14
v 12/14) (MES median number 50 v 112, p=0.2).
CONCLUSIONA high number of MES were detected in
patients with VR with neuropsychological deficit. In patients with CABG
with such a deficit, a low number of MES were detected. This difference
in number may be explained by relatively more gaseous emboli in the first and more solid in the second. However, the results in the patients with CABG should be interpreted with caution due to the few
patients in this subgroup.
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