Continuum, February 2005, Volume 11, Issue 1

Coronary artery bypass grafting (CABG) can successfully relieve angina. However, neurological and cognitive adverse events-specifically stroke, encephalopathy (delirium), and depression, including short-term and long-term depression-may be associated with CABG. Patients at higher risk for stroke and/or encephalopathy can be identified prior to surgery. For these "high-risk" patients alternative approaches to conventional on-pump CABG may be considered. Short-term cognitive changes are reversible in most patients. Longer-term cognitive changes may be more related to underlying cerebrovascular disease than CABG.(C) 2005 American Academy of Neurology

Electrolyte disorders are a common cause for neurological dysfunction in medically ill patients. Hyperosmolarity is frequently seen in neurological patients who have become volume depleted for an array of reasons ranging from their underlying neurological disease to the toxicity of many drugs and the effects of common metabolic disturbances such as hyperglycemia. Hyponatremia may develop slowly over many weeks or months with few neurological manifestations or may occur rapidly, leading to seizures and malignant cerebral edema. Treatment depends on an understanding of the brain's mechanisms for compensating for alterations in serum sodium concentrations. Correction of chronic hyponatremia should be done slowly and with great caution, while correction of acute hyponatremia requires rapid and aggressive management in order to prevent death from brain swelling. The management of hypokalemia and hyperkalemia depends upon understanding the metabolic handling of this electrolyte that is so important for the normal function of muscle, including that in the heart and its conducting system.(C) 2005 American Academy of Neurology

Inflammation is an important cause of many human diseases, including classical diseases of the nervous system, such as meningitis, encephalitis, some neuropathies, and multiple sclerosis. In recent years, it has become clear that low-level inflammation may be an important cause of vascular disease, including the development of atherosclerosis and the rupture of plaques that mark the onset of myocardial infarction. Markers for low-grade inflammation may be easily measured in the blood and may mark a population of people at unusually high risk for vascular events such as myocardial infarction and stroke. Inflammation has been traditionally believed to be a completely local phenomenon, but recent information clearly indicates that it is elegantly regulated by the nervous system via what is now known as the inflammatory reflex. Many neurological diseases, including migraine and the traditional degenerative diseases such as Alzheimer's disease, may have an inflammatory component. Control of low-level inflammation could be a therapeutic target for future approaches in slowing the course of many neurological diseases.(C) 2005 American Academy of Neurology