Psychopatho-ophthalmology, gnostic disorders, and psychosis in cardiac surgery

Abstract

The visual disturbances of 45 patients following open heart surgery could be divided into disturbances of (1) visual acuity, (2) visual accuracy, and (3) visual reality testing. The non-hallucinatory phenomena consisted mainly of loss of colour vision, metamorphopsias, visual gnostic disorders and cortical blindness. The hallucinatory phenomena could be divided into the delirium type of hallucinations with clouding of consciousness and the spectator type of hallucinations with a clear sensorium. The causes of the visual symptomatology and cardiac psychoses are seen in microembolization and/or ischemic hypoxia. The basal ganglia and the occipital lobe are areas of predilection for embolic and hypoxic changes. Identical psychoses also occur in cerebral malaria and polycythemia vera which show the same embolic and anoxic neuropathological changes of vascular occlusion as do many patients who die following open heart surgery with extracorporal circulation.

Off-pump coronary artery revascularization in octogenarians: is it better?

“…In a small, prospective randomized study (n ¼ 20), Ascione et al [111] documented ophthalmic microembolization in 55% of on-pump patients, whereas none was recorded in off-pump. Microembolizations to the basal ganglia and occipital lobe can cause psychosis and visual disturbance after open heart surgery [112][113][114]. Similar phenomena have been observed in cerebral malaria and polycythemia, diseases known to cause similar embolic and anoxic neuropathologic changes in these areas of the brain.…”

“Other” Neurologic Complications After Cardiac Surgery

“…In addition to cortical blindness, if the ischemic damage also involves the basal ganglia, problems may arise with visual acuity, reality testing, and visual perception. 75 These lesions, often involving altered levels of consciousness, can impact perception of length, distance, and proximity. Patients have difficulty with tasks such as naming objects by sight, determining which of two objects is larger, judging the distance to obstacles when walking, or recognizing familiar faces.…”

“…Altered levels of consciousness may also lead some patients to not realize their visual deficits, even to the point of denying complete blindness. 75 Cortical lesions are rarely associated with a change in color perception.…”

Effects of Enflurane on Visual Evoked Potentials in Humans

“…Even though recording of the visual evoked potentials (VEP) is vulnerable to various factors during surgery, it has been used in monitoring function of the central nervous system during cardiopulmonary bypass, as disturbance of visual function is one of the most common complications following cardiovascular surgery [5][6][7]. Others used VEP in monitoring integrity of the visual pathways during neurosurgical procedures [8,9].…”