From the Research
Seizures after coronary artery bypass grafting (CABG) surgery are often caused by hypoperfusion during surgery, embolic events, metabolic disturbances, medication effects, or withdrawal from alcohol or sedatives, and require prompt evaluation and management to prevent morbidity and mortality. The most common causes of post-CABG seizures include:
- Hypoperfusion during surgery
- Embolic events
- Metabolic disturbances (particularly hypoglycemia, hyponatremia, or hypocalcemia)
- Medication effects
- Withdrawal from alcohol or sedatives According to the study by 1, delirium after CABG surgery is a strong independent predictor of mortality up to 10 years postoperatively, especially in younger individuals and in those without prior stroke. However, this study does not directly address the causes of seizures post-CABG surgery.
The study by 2 discusses cognitive decline after CABG surgery, but does not provide information on the causes of seizures. The study by 3 compares changes in cognitive performance at 3 and 12 months after CABG with those in a control group of patients with comparable risk factors for coronary artery disease (CAD) who had not undergone surgery, but also does not provide information on the causes of seizures.
The study by 4 investigates image quality and diagnostic performance of computed tomography angiography (CTA) in patients with previous CABG surgery, but does not address the causes of seizures. The study by 5 discusses pleural effusions following cardiac injury and coronary artery bypass graft surgery, but is not relevant to the causes of seizures.
In terms of management, immediate treatment of seizures post-CABG surgery includes intravenous benzodiazepines such as lorazepam 2-4 mg or diazepam 5-10 mg to stop the seizure, and urgent neuroimaging (CT or MRI) should be performed to rule out stroke, hemorrhage, or other structural causes. Laboratory tests should include electrolytes, glucose, calcium, magnesium, complete blood count, and drug levels if applicable. EEG monitoring may be necessary for ongoing seizure activity or altered mental status. Maintenance antiseizure medication is typically continued for 3-6 months if no structural lesion is identified, with levetiracetam often preferred due to fewer drug interactions. Addressing underlying causes such as correcting electrolyte abnormalities is essential for preventing recurrence. Neurological consultation should be obtained as soon as possible to guide further management and determine the duration of antiseizure therapy.