Subsequent intracranial haemorrhage following open heart surgery

Abstract

Intracranial haemorrhage (ICH) is an uncommon but lethal complication of open heart surgery. The aim of the present paper is to analyse studies of ICH subsequent to open heart surgery and further to discuss the risk factors and strategies. Articles were obtained from Index Medicus/MEDLINE database of the National Library of Medicine USA from 1966 to present, and the Chinese Biomedical Literature Database (CBMDISC) of the Institute of Medical Information of Chinese Academy of Medical Sciences from January 1982 to December 2000. Search terms included cardiopulmonary bypass, cardioplegia, neurosurgery, craniotomy, sphenotresia, ICH, intracranial haematoma, haemorrhagic stroke/infarct and craniocerebral injury. Information obtained from the cited literature helped complete the collection of the documents. In total 35 reports covering 179 cases are reviewed. Of the 182 ICHs of 179 patients after open heart surgery, intracerebral haemorrhage was the most frequent (41.21%), subdural haematoma was the second (22.53%) and epidural haematoma was the third (12.64%). Of the 77 sites of ICHs that can be traced, the frontal region was involved the most (23.34%) and the parietal, occipital and temporoparietal regions second (each was 12.99%). It occurred most often on the right (55.84%), more often on the left (31.77%), and the least often on bilateral (12.99%) sides of the brain. Haemorrhage in intracerebral was most common (40.66%), sudural the second (22.53%), then epidural (12.64%) and subarachnoid (3.85%) and the least common in multiple sites. Sixty‐eight (37.36%) of the patients were treated by craniotomy for haematoma evacuation, 30 (16.48%) by conservative treatment, 27 (14.84%) were not treated in time and died, and the other 57 (31.32%) treatment methods are unknown. Forty‐two patients (23.08%) survived, one of whom (0.55%) was in a vegatative state, 103 (56.59%) died and 37 (20.33%) have unknown outcomes. ICH following open heart surgery is rare but risky and always life threatening. Any factors leading to cerebrovascular injury or fluid shifts with fluctuations in cerebral volume during pre‐, intra‐ or postoperation of open heart surgery may cause ICH. Computed tomography scan optimizes the detection of ICH. Miscellaneous prophylactic approaches are mandatory for patients vulnerable to ICH following open heart surgery. Therapeutic approaches as either antibiotics or early operations should be determined on a substantial basis of prosthetic endocarditis patients with ICHs.