Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA, United States.
Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA, United States; Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, United States.
Handb Clin Neurol. 2021;177:65-75. doi: 10.1016/B978-0-12-819814-8.00007-X.
Cardiac surgeries are commonly associated with neurologic complications. The type and complexity of the surgery, as well as patients' comorbidities, determine the risk for these complications. Awareness and swift recognition of these complications may have significant implications on management and prognosis. Recent trials resulted in an expansion of the time window to treat patients with acute ischemic stroke with intravenous thrombolysis and/or mechanical thrombectomy using advanced neuroimaging for screening. The expanded time window increases the reperfusion treatment options for patients that suffer a periprocedural ischemic stroke. Moreover, there is now limited data available to help guide management of intracerebral hemorrhage in patients undergoing treatment with anticoagulation for highly thrombogenic conditions, such as left ventricular assist devices and mechanical valves. In addition to cerebrovascular complications patients undergoing heart surgery are at increased risk for seizures, contrast toxicity, cognitive changes, psychological complications, and peripheral nerve injuries. We review the neurological complications associated with the most common cardiac surgeries and discuss clinical presentation, diagnosis and management strategies.
心脏手术通常与神经系统并发症相关。手术的类型和复杂性，以及患者的合并症，决定了这些并发症的风险。对这些并发症的认识和迅速识别可能对管理和预后有重大影响。最近的试验结果扩大了时间窗，以便使用先进的神经影像学筛查，对急性缺血性卒中患者进行静脉溶栓和/或机械取栓治疗。扩大的时间窗增加了接受经皮冠状动脉介入治疗的患者的再灌注治疗选择。此外，对于因左心室辅助装置和机械瓣膜等高度血栓形成情况而接受抗凝治疗的患者，目前可用的数据有限，无法帮助指导其脑出血的管理。除了脑血管并发症，接受心脏手术的患者还面临癫痫发作、造影剂毒性、认知变化、心理并发症和周围神经损伤的风险增加。我们回顾了与最常见的心脏手术相关的神经并发症，并讨论了临床表现、诊断和管理策略。
