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Departments of Neurology (Drs. Schmidt, Fazekas, Offenbacher, Freidl, Payer, and Lechner) and Cardiac Surgery (Drs. Mächler and Rigler), Karl-Franzens University Graz, Austria; and the Department of Neurology (Dr. Harrison), Middlesex Hospital, London, UK.
We undertook a study to determine (1) the frequency and prognostic significance of preexisting MRI brain abnormalities in patients undergoing coronary artery bypass grafts (CABG) and (2) whether MRI can detect surgery-related brain damage in 31 neurologically asymptomatic CABG patients (mean age, 61.0 ± 6.6 years). MRIs were performed within 7 days before and 8 to 17 days after surgery. When we compared the preoperative images with those of 31 age- and risk factor-matched neurologically asymptomatic controls free of cardiac disease (mean age, 60.3 ± 6.1 years), higher rates of thromboembolic infarcts (16% versus 0%), lacunes (58.1% versus 32.3%), and brainstem lesions (22.6% versus 3.8%) were noted. Subjective rating demonstrated significantly larger ventricles in patients than in controls (p = 0.002). CABG candidates also had significantly increased ventricular-to-intracranial cavity ratios (VICR) as determined by semiquantitative volumetric measurements (6.9 ± 2.5% versus 4.9 ± 1.6%; p = 0.0004). Eleven patients had postsurgical complications, with eight having symptoms consistent with diffuse encephalopathy. The only MRI finding that separated encephalopathic from complication-free patients was ventricular size (VICR 9.0 ± 2.5% versus 4.9 ± 1.6%; p = 0.006). This difference remained statistically significant after adjustment for the effects of age (p = 0.04). Postoperative MRI consistently failed to demonstrate surgery-related brain damage responsible for the encephalopathy.
Address correspondence and reprint requests to Dr. Reinhold Schmidt, Department of Neurology, Karl-Franzens University Graz, Auenbruggerplatz 23, A-8036 Graz, Austria.
Support for the investigation of controls was given by the "Jubilaeumsfond" of the Austrian National Bank-Project #3905.
Received June 3, 1992. Accepted for publication in final form August 14, 1992.
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