Electroencephalographic seizures during cardiopulmonary bypass

Abstract

SYNOPSIS Eleven cardiac operations are reported in which there was electroencephalographic and/or clinical evidence of seizure activity during cardiopulmonary bypass (CPB). In four patients seizure activity appeared after acute episodes of cerebral ischaemia resulting from either hypotension or pump-generated emboli occurring at the beginning of CPB, or from air embolism occurring at the end of CPB when the myocardium was closed and defibrillated. In the remaining seven patients the seizures appeared to result from the synergistic action of a toxic substance in the perfusate with pre-existing or CPB-induced alterations in cerebral physiology.While numerous reports have appeared over the last 15 years documenting the depression of electrocortical activity which frequently accompanies cardiopulmonary bypass (CPB) (Theye et al., 1957;Silverstein et al., 1960;Lorenz and Hehrlein, 1970), excitatory or epileptiform electroencephalographic (EEG) activity associated with CPB has rarely been observed. The lack of data on epileptic phenomena during CPB may partly reflect the relative infrequency with which the intraoperative EEG is recorded and the use of neuromuscular blocking agents during CPB which would mask any clinical manifestations of seizures. Although probably very rare, seizure activity during CPB is of clinical importance inasmuch as it represents a potentially fatal complication of open-heart surgery. The dangers of having a violent motor seizure during a critical portion of the surgical procedure are obvious. Even if complete neuromuscular blockade is present at the time that electrical seizure activity initially develops, the later unmasking of motor convulsions as the muscle relaxants wear off could pose an unallowable circulatory stress (Storm van Leeuwen et al., 1961). The possibilities of progression to status epilepticus (Seamans et al., 1968;Radvanyi et al., 1970) or of 'consumption anoxia' of the cerebral cortex resulting from the greatly increased oxygen demands of the discharging neurones (Davies and 181 Remond, 1947;Meyer and Waltz, 1961) further suggest the desirability of controlling even a purely electrographic seizure during CPB.The present study investigates the electroencephalographic and clinical circumstances of a number of epileptic seizures occurring during extracorporeal circulation in an attempt to elucidate underlying mechanisms and appropriate therapy of these phenomena and their possible relevance to clinical epilepsy. METHODEleven electrographic seizures during CPB are reported which occurred in a combined series of 280 patients undergoing cardiac surgery with CPB at our hospitals between 1965 and

Epileptic Seizures Due to Thrombotic and Embolic Cerebrovascular Disease in Older Patients

“…In this study plus four others (Branthwaite, 1972(Branthwaite, , 1973Casteneda et al, 1974;Stockard et al, 1974), seizures occurred in 21 of 900 patients. Suggested causes of neurologic deficits of any kind after cardiac surgery have included age (Tufo et al, 1970;Branthwaite, 1973;Stockard et al, 1973), atherosclerosis (Branthwaite, 1973;Stockard et al, 1973;Bojar et al, 1983), perfusion duration (Tufo et al, 1970;Branthwaite, 1973;Aberg and Kihlgren, 1977), toxins (Dobell et al, 1966;Stockard et al, 1974), metabolic changes (Fischer-Williams and Cooper, 1964), alveolar collapse (Fischer-Williams and Cooper, 1964), use of all blood primers (Branthwaite, 1973), emboli whether due to atheromata or air (Brierley, 1964;Aberg and Kihlgren, 1977;Bojar et al, 1983), and hypotension with or without decreased cardiac output (Brierley, 1964;Fischer-Williams and Cooper, 1964;Tufo et al, 1970;Castaneda et al, 1974;Bojar et al, 1983;Breuer et al, 1983). These hypotheses were formulated over a number of years and many of the factors once considered no longer seem as important.…”

Incidence, risk factors, and outcomes in electroencephalographic seizures after mechanical circulatory support: A systematic review and meta-analysis

“…Based on the modified NOS scale, 9 in 13 studies of the adult population and 31 in 47 studies of the pediatric population scored 4 points or more, demonstrating low or moderate risks of bias. Two studies reported both the adult and pediatric population ( 14 , 15 ), and the sample size of some studies is relatively small and the reporting year is from 1974 to 2021, which may be attributed to the selection bias. The second bias derives primarily from the evaluation of outcomes.…”

Electroencephalographic findings after convulsive seizures due to cerebral arterial air embolism secondary to lung cancer: a case report

“…Notably, the EEG findings were consistent with the changes associated with CAE in the bilateral cerebral hemispheres. A few reports have described EEG findings in CAE due to invasive iatrogenic or noniatrogenic etiologies, such as lung cancer (present case), lung transplantation, patent foramen ovale, esophageal cancer, or scuba diving, for example, “epileptiform electroencephalographic activities with a spike” during cardiopulmonary bypass [ 3 ], “epileptiform disturbance” during mitral valve replacement [ 4 ], “non-convulsive status epileptics” in lung transplantation [ 5 ], “focal seizure during hyperventilation” in a patient with a bronchogenic cyst [ 6 ], and “normal EEG” after scuba diving [ 7 ]. In our patient, focal spikes and diffuse slow waves were caused by CAE of noniatrogenic etiology, which consists of CAE due to invasive iatrogenic mechanism and noniatrogenic mechanisms, as reported previously.…”