J Clin Neurol.  2014 Oct;10(4):367-370. 10.3988/jcn.2014.10.4.367.

Saccadic Palsy after Cardiac Surgery: Serial Neuroimaging Findings during a 6-Year Follow-Up

• Kim EJ
• Choi KD
• Kim JE
• Kim SJ
• Kim JS
• Kim JS
• Jeong JH

• KMID: 2287519
• DOI: http://doi.org/10.3988/jcn.2014.10.4.367

Abstract

BACKGROUND
Patients who develop horizontal and vertical saccadic palsy after cardiac surgery have rarely been described. Although most such patients exhibit distinct neurological deficits, their brain MRI findings are almost normal. In addition, functional neuroimaging of such patients has never been reported.
CASE REPORT
A 43-year-old woman with dysarthria, dysphagia, and horizontal and vertical saccadic palsy after cardiac surgery was followed up for about 6 years; serial brain MRIs has been performed during this period, including susceptibility-weighted imaging (SWI) and [18F]-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET). Multiple microbleeds in the cerebral cortex, cerebellum, and brainstem, and glucose hypometabolism in the brainstem, cerebellum, and multiple cortical areas.
CONCLUSIONS
To the best of our knowledge, this is the first reported case of saccadic palsy after cardiac surgery with serial SWI and [18F]-FDG-PET performed to explore the possible cerebral lesions.

Keyword

saccade; cardiac surgery; [18F]-FDG-PET; SWI

MeSH Terms

Adult
Brain
Brain Stem
Cerebellum
Cerebral Cortex
Deglutition Disorders
Dysarthria
Female
Follow-Up Studies*
Functional Neuroimaging
Glucose
Humans
Magnetic Resonance Imaging
Neuroimaging*
Paralysis*
Positron-Emission Tomography
Saccades
Thoracic Surgery*
Glucose

Figure

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  Fig. 1 Decreased glucose metabolism throughout the brainstem, cerebellum, and bilateral medial temporal and left parietal areas was detected by axial [18F]-fluoro-2-deoxy-D-glucose positron-emission tomography performed 1 year (A), 4 years (B), and approximately 6 years (C) after cardiac surgery.

• 

  Fig. 2 Susceptibility-weighted imaging performed 4 years (A) and approximately 6 years (B) after onset revealed multiple microbleeds (white arrows) in the midbrain, pons, left cerebellum, and bilateral parietal areas.

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  Fig. 3 Glucose hypometabolism in the brainstem of the patient (A) was more prominent and severe than that in a 43-year-old female patient with Alzheimer's disease (B).

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