Tremors After Coronary Artery Bypass Graft Surgery: A Case of Parkinsonism Following Heart Surgery

1Johns Hopkins Bayview Medical Center, Baltimore, MD
2Kakatiya Medical College, Warangal, India
3Johns Hopkins Bayview Medical Center, Baltimore, MD
4Shadan Institute of Medical Sciences, Hyderabad, India
5Deccan College of Medical Sciences, Hyderabad, India

Meeting: Hospital Medicine 2013, May 16-19, National Harbor, Md.

Abstract number: 491

Case Presentation:

This 67‐year‐old white male patient with a medical history of diabetes mellitus type 2, hypertension, dyslipidemia, coronary artery disease, and congestive heart failure (EF 20%) presented to the hospital with decompensated heart failure. The patient had a cardiac catheterization that revealed triple‐vessel disease and an echocardiogram that revealed a patent foramen ovale (PFO). He underwent three vessel coronary artery bypass graft (CABG) surgery and closure of PFO as a part of treatment for his ischemic cardiomyopathy. His postoperative recovery was protracted and complicated by aspiration pneumonia. Given his weakness and slow recovery he was sent to inpatient rehabilitation where he stayed for a month. On his follow‐up visits it was noticed that he continued to have difficulty with ambulation and demonstrated tremors and bradykinesia that were new from his baseline functional status prior to surgery. The patient was readmitted to the hospital 4 months after his CABG with progressively worsening weakness and inability to ambulate. On examination patient had all the classic signs and symptoms of parkinsonism like cogwheel rigidity, shuffling gait, bradykinesia, tremors, and normal cognitive function. He had a normal CT brain. His basic lab work was unimpressive. Neurology was consulted who agreed with the diagnosis of Parkinsonism and started patient on treatment. The most probable cause was vascular parkinsonism caused by a complication of CABG surgery vs. idiopathic Parkinson's disease unmasked after the surgery.

Discussion:

Neurological complications are common post‐CABG surgery. While stroke is the most concerning complication other neuropsychiatric complications like depression, cognitive impairment and Parkinsonism also occur. Neurological complications can lead to increased length of stay, morbidity, readmissions and mortality in patients. As hospitalists it is essential to recognize the wide spectrum of neurological complications after a CABG surgery. Parkinsonism has been reported as a complication following open heart surgeries. It occurs from cerebrovascular ischemia. A delay in diagnosis can lead to debility and increased morbidity in these patients. Parkinson's disease patients who are hospitalized for any reason experience deterioration in their disease condition. Incorrect medications and infections have shown to worsen Parkinsonism in hospitalized patients. As hospitalists, early detection of this condition, initiation or continuation of the right medications and early discharge can best help these patients.

Conclusions:

We present a rare case of parkinsonism presenting as a neurological complication after coronary artery bypass surgery to add to the literature.

To cite this abstract:

Gundareddy V, Ravi G, Bollampally P, Ravi S, Thamtam V. Tremors After Coronary Artery Bypass Graft Surgery: A Case of Parkinsonism Following Heart Surgery. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 491. https://www.shmabstracts.com/abstract/tremors-after-coronary-artery-bypass-graft-surgery-a-case-of-parkinsonism-following-heart-surgery/. Accessed December 10, 2018.

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