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Tools for Assessing Central Nervous System Injury in the Cardiac Surgery Patient

  • Chapter
Brain Injury and Protection During Heart Surgery

Abstract

Despite improvements in surgical, anesthetic, and perfusion techniques in recent years, central nervous system (CNS) complications remain “a principal cause of the morbidity after open-heart surgery” [1]. Just as the improvement in cardiac outcome owes much to the growth in the number and sophistication of the tools to measure cardiac function, having better tools to assess brain function will contribute to development of new ways of avoiding CNS damage due to cardiopulmonary bypass (CPB). The importance to the CNS of oxygenator design, perfusion flow, pressure, arterial filtering, carbon dioxide tension, pharmacologic protection, and other factors can only be evaluated if proper measuring tools are available to the investigators.

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References

  1. Taylor KM: (1982) Brain damage during open-heart surgery (Editorial). Thorax 37:873–876.

    PubMed  CAS  Google Scholar 

  2. Roizen MF: (1984) But what does it do to outcome? (Editorial). Anesth Analg 63:789–790.

    PubMed  CAS  Google Scholar 

  3. McLesky CH, Cheney FW: (1982) A correctable complication of cardiopulmonary bypass. Anesthesiology 56:214–216.

    Google Scholar 

  4. Krous HF, Mansfield PB, Sauvage LR: (1973) Carotid hyperperfusion during open heart surgery. J Thorac Cardiovasc Surg 66:118–121.

    PubMed  CAS  Google Scholar 

  5. Plum F, Posner JB: (1980) The Diagnosis of Stupor and Coma. Philadelphia: FA Davis.

    Google Scholar 

  6. Theye RA, Patrick RT, Kirklin JW: (1957) The electroencephalograph in patients undergoing intracardiac operations with the aid of extracorporeal circulation. J Thorac Surg 34: 706–716.

    Google Scholar 

  7. Pronk RAF, Simons AJR. (1984) Processing the electroencephalogram in cardiac surgery. Comput Programs Biomed 18:181–190.

    PubMed  CAS  Google Scholar 

  8. Levy WJ, Shapiro HM, Maruchak G, Meathe E: (1980) Automated EEG processing for intraoperative monitoring: a comparison of techniques. Anesthesiology 53:223–236.

    PubMed  CAS  Google Scholar 

  9. Levy WJ: (1984) Intraoperative EEG patterns: Implications for EEG monitoring. Anesthesiology 60:430–434.

    PubMed  CAS  Google Scholar 

  10. Levy WJ, Grundy BL, Smith NT: (1984) Monitoring the electroencephalogram and evoked potentials during anesthesia. In Monitoring in Anesthesia, 2nd edition, L.J. Saidman and N.T. Smith. Boston: Butterworths, pp. 227–267.

    Google Scholar 

  11. Prior PF: (1985) EEG monitoring and evoked potentials in brain ischaemia. Br J Anaesth 57:63–81.

    PubMed  CAS  Google Scholar 

  12. Grundy BL: (1983) Electrophysiologic monitoring: electroencephalography and evoked potentials. In Handbook of Neuroanesthesia, P. Newfield and J.E. Cottrell (eds.). Boston: Little, Brown and Company, pp. 28–59.

    Google Scholar 

  13. Mohr JP: (1979) Neurological complications of cardiac valvular disease and cardiac surgery including systemic hypotension. In Handbook of Clinical Neurology, Vol. 38, Neurological Manifestations of Systemic Diseases, Part I, PJ Vinken, GW Bruyn, and HL Klawans (eds.). New York: North-Holland, pp. 143–171.

    Google Scholar 

  14. Cotter D: (1983) EEG monitoring during open heart surgery. Health technology assessment report, No. 1. (Available from National Technical Information Service as Assession No. PB85 192789)

    Google Scholar 

  15. Anonymous. (1986) EEG monitors. Health Devices 15:70–95.

    Google Scholar 

  16. Sharbrough FW, Messick JM Jr, Sundt TM Jr: (1983) Correlation of continuous electroencephalograms with cerebral blood flow measurements during carotid endarterectomy. Stroke 4:674–683.

    Google Scholar 

  17. Chiappa KH, Burke SR, Yound RR. (1979) Results of electroencephalographic monitoring during 367 carotid endarterectomies: Use of a dedicated minicomputer. Stroke 10:381–388.

    PubMed  CAS  Google Scholar 

  18. Rosenthal D, Stanton PE Jr, Lamis PA: (1981) Carotid endarterectomy—the unreliability of intraoperative monitoring in patients having had stroke or reversible ischemic neurologic deficit. Arch Surg 116:1569–1575.

    PubMed  CAS  Google Scholar 

  19. Ferguson GG: (1982) Intra-operative monitoring and internal shunts: Are they necessary in carotid endarterectomy? (Editorial). Stroke 13:287–289.

    PubMed  CAS  Google Scholar 

  20. Sebel PS, Bovill JG, Wauquier A, Rog P: (1981) Effects of high-dose fentanyl anesthesia on the electroencephalogram. Anesthesiology 55:203–211.

    PubMed  CAS  Google Scholar 

  21. Wright JS, Lethlean AK, Hicks RG, Torda TA, Stacey R: (1972) Electroencephalographic studies during open-heart surgery. J Thorac Cardiovasc Surg 63:631–638.

    PubMed  CAS  Google Scholar 

  22. Michaels I, Sheehan J: (1984) EEG changes due to unsuspected aortic dissection during cardiopulmonary bypass. Anesth Analg 63:946–948.

    PubMed  CAS  Google Scholar 

  23. Branthwaite MA: (1973) Detection of neurological damage during open-heart surgery. Thorax 28:464–472.

    PubMed  CAS  Google Scholar 

  24. Shapiro HM. (1984) Monitoring in neurosurgical anesthesia. In Monitoring in Anesthesia, 2nd edition, LJ. Saidman and NT. Smith. Boston: Butterworths, pp. 273–275.

    Google Scholar 

  25. Kritikou PE, Branthwaite MA: (1977) Significance of changes in cerebral electrical activity at onset of cardiopulmonary bypass. Thorax 32:534–538.

    PubMed  CAS  Google Scholar 

  26. Ross Russell RW, Bharucha N: (1978) The recognition and prevention of border zone cerebral ischaemia during cardiac surgery. Q J Med 47:303–323.

    Google Scholar 

  27. Sotaniemi KA, Sulg IA, Hokkanen TE: (1980) Quantitative EEG as a measure of cerebral dysfunction before and after open-heart surgery. Electroencephalogr Clin Neurophysiol 50:81–95.

    PubMed  CAS  Google Scholar 

  28. Malone M, Prior PF, Scholtz CL. (1981) Brain damage after cardiopulmonary by-pass: Correlations between neurophysiological and neuropathological findings. J Neurol Neurosurg Psychiatry 44:924–931.

    PubMed  CAS  Google Scholar 

  29. Myers RR, Stockard JJ, Saidman LJ: (1977) Monitoring of cerebral perfusion during anesthesia by time-compressed Fourier analysis of the electroencephalogram. Stroke 8:331–337.

    PubMed  CAS  Google Scholar 

  30. Sebel PS, Maynard DE, Major E, Frank M: (1983) The cerebral function analysing monitor (CFAM) a new microprocessor-based device for the on-line analysis of the EEG and evoked potentials. Br J Anaesth 55:1265–1270.

    PubMed  CAS  Google Scholar 

  31. Rampil IJ, Sasse FJ, Smith NT, Hoff BH, Flemming DC: (1980) Spectral edge frequency— a new correlate of anesthetic depth (abstract). Anesthesiology 53:S12.

    Google Scholar 

  32. Levy WJ, Shapiro HM, Meathe E: (1980). The identification of rhythmic EEG artifacts by power spectrum analysis. Anesthesiology 53:505–507.

    PubMed  CAS  Google Scholar 

  33. Glaria AP, Murray A: (1985) Comparison of EEG monitoring techniques: An evaluation during cardiac surgery. Electroencephalogr Clin Neurophysiol 61:323–330.

    PubMed  CAS  Google Scholar 

  34. Rampil IJ, Holzer JA, Quest DO, Rosenbaum SH, Correll JW: (1983) Prognostic value of computerized EEG analysis during carotid endarterectomy. Anesth Analg 62:186–192.

    PubMed  CAS  Google Scholar 

  35. Bnerley JB, Prior PF, Calverley J, Jackson SJ, Brown AW: (1980) The pathogenesis of ischaemic neuronal damage along the cerebral arterial boundary zones in papio anubis. Brain 103:929–965.

    Google Scholar 

  36. Lorenz R and Hehrlein F: (1970) Electroencephalographic findings in heart surgery. Minn Med 53:1069–1076.

    PubMed  CAS  Google Scholar 

  37. Smith NT, Westover CJ Jr, Quinn M, Benthuysen JL, Dec-Silver H, Sanford TJ Jr: (1985) An electroencephalographic comparison of alfentanil with other narcotics and with thiopental. J Clin Monit 1:236–244.

    PubMed  CAS  Google Scholar 

  38. Smith NT, Dec Silver H, Sanford TJ, Westover CJ Jr, Quinn ML, Klein F, Davis DA: (1984) Changes in the electroencephalogram during high-dose narcotic anesthesia. In Opioids in Anesthesia, F. G. Estafanous (ed.). Boston: Butterworth Publishers, pp. 61–66.

    Google Scholar 

  39. Nussmeier NA, Arlund C, Slogoff S: (1986) Neuropsychiatric complications after cardiopulmonary bypass: Cerebral protection by a barbiturate. Anesthesiology 64:165–170. (see also accompanying editorial, op. cit., pp 140–141.)

    PubMed  CAS  Google Scholar 

  40. Hicks RG, Poole JL: (1981) Electroencephalographic changes with hypothermia and cardiopulmonary bypass in children. J Thorac Cardiovasc Surg 81:781–786.

    PubMed  CAS  Google Scholar 

  41. Reilly EL, Brunberg JA, Doty DB: (1974) The effect of deep hypothermia and total circulatory arrest on the electroencephalogram in children. Electroencephalogr Clin Neurophysiol 36:661–667.

    PubMed  CAS  Google Scholar 

  42. Massaut J, Dubois-Primo J, Deville A, Govaerts MJM, Deuvaert F: (1984) Fourier analysis demonstrates EEG slowing after circulatory arrest at 20°C. Acta Anaesth Belg 35 (Suppl.): 371–378.

    PubMed  Google Scholar 

  43. Levy WJ: (1984) Quantitative analysis of EEG changes during hypothermia. Anesthesiology 60:291–297.

    PubMed  CAS  Google Scholar 

  44. Ichiyanagi K, Matsuki M, Masuko K, Nishisaka T, Watanabe R, Horikawa H: (1969) Effect of altered arterial carbon dioxide tensions on the electroencephalogram during hypothermia. Acta Anaesth Scand 13:173–183.

    PubMed  CAS  Google Scholar 

  45. Juneja I, Flynn RE, Berger RL: (1972) The arterial pH, pCO2 and the electroencephalogram during open heart surgery. Acta Neurol Scand 48:169–175.

    PubMed  CAS  Google Scholar 

  46. Branthwaite MA: (1973) Factors affecting cerebral activity during open-heart surgery. Anesthesia 28:619–625.

    CAS  Google Scholar 

  47. Juneja I, Flynn RE, Berger RL: (1972) The arterial, venous pressures and the electroencephalogram during open heart surgery. Acta Neurol Scand 48:163–168.

    PubMed  CAS  Google Scholar 

  48. Slogoff S, Girgis KZ, Keats AS: (1982) Etiologic factors in neuropsychiatric complications associated with cardiopulmonary bypass. Anesth Analg 61:903–911.

    PubMed  CAS  Google Scholar 

  49. Witoszka MM, Tamura H, Indeglia R, Hopkins RW, Simeone, FA: (1973) Electroencephalographic changes and cerebral complications in open-heart surgery. J Thorac Cardiovasc Surg 66:855–864.

    PubMed  CAS  Google Scholar 

  50. Vecchio TJ: (1966) Predictive value of a single diagnostic test in unselected populations. N Engl J Med 274:1171–1173.

    PubMed  CAS  Google Scholar 

  51. Schwartz MS, Colvin MP, Prior PF, Strunin L, Simpson BR, Weaver EJM, Scott DF: (1973) The cerebral function monitor: Its value in predicting the neurological outcome in patients undergoing cardiopulmonary by-pass. Anaesthesia 28:611–618.

    PubMed  CAS  Google Scholar 

  52. Salerno TA, Lince DP, White DN, Lynn RB, Charrette EJP: (1978) Monitoring of electroencephalogram during open-heart surgery. J Thorac Cardiovasc Surg 76:97–100.

    PubMed  CAS  Google Scholar 

  53. Salerno TA, Lynn RB, White DN, Charrette EJP: (1979) Cerebral surveillance during cardiac surgery. Can J Surg 22:325–326.

    PubMed  CAS  Google Scholar 

  54. Grundy BL: (1983) Intraoperative monitoring of sensory-evoked potentials. Anesthesiology 58:72–87.

    PubMed  CAS  Google Scholar 

  55. Durkin MA, Hume A, Van Ess D, Kopf GS: (1985) Reliable and reproducible neurologic information using somatosensory evoked potential monitoring during hypothermic cardiopulmonary bypass (abstract). Anesthesiology 63:A72.

    Google Scholar 

  56. Rosenblum SM, Ruth RA, Gal TJ: (1985) Brain stem auditory evoked potential monitoring during profound hypothermia and circulatory arrest. Ann Otol Rhinol Laryngol 94:281–283.

    PubMed  CAS  Google Scholar 

  57. Aren C, Badr G, Feddersen K, Radegran K: (1985) Somatosensory evoked potentials and cerebral metabolism during cardiopulmonary bypass with special reference to hypotension induced by prostacyclin infusion. J Thorac Cardiovasc Surg 90:73–79.

    PubMed  CAS  Google Scholar 

  58. Takaki O, Okumura F: (1985) Application and limitation of somatosensory evoked potential monitoring during thoracic aortic aneurysm surgery: A case report. Anesthesiology 63:700–703.

    PubMed  CAS  Google Scholar 

  59. Levy WJ, York DH, McCaffrey M, Tanzer F: (1984) Motor evoked potentials from transcranial stimulation of the motor cortex in humans. Neurosurgery 15:287–302.

    PubMed  CAS  Google Scholar 

  60. Sotaniemi KA: (1983) Cerebral outcome after extracorporeal circulation: comparison between prospective and retrospective evaluation. Arch Neurol 40:75–77.

    PubMed  CAS  Google Scholar 

  61. Breuer AC, Furlan AJ, Hanson MR, Lederman RJ, Loop FD, Cosgrove DM, Greenstreet RL, Estafanous FG: (1983) Central nervous system complications of coronary artery bypass graft surgery: Prospective analysis of 421 patients. Stroke 14:682–686.

    PubMed  CAS  Google Scholar 

  62. Lezak MD: (1983) Neuropsychological Assessment, 2nd edition. New York: Oxford University Press.

    Google Scholar 

  63. Wechsler D: (1981) Wechsler Adult Intelligence Scale—Revised. New York: Harcourt, Brace and Javonovich.

    Google Scholar 

  64. Guertin WH, Ladd CE, Frank GH, Rabin AI, Hiestu DS: (1966) Research with the Wechsler Intelligence Scales for Adults: 1960–1965. Psychol. Bull. 66:385–409.

    PubMed  CAS  Google Scholar 

  65. Zachory RA, Crumpton E, Spiegel DE: (1985) Estimting WAIS-R I.Q. from the Shipley Institute of Living Scale. J Clin Psychol 41:582–540.

    Google Scholar 

  66. Adam N: (1979) Disruption of memory functions associated with general anesthetics. In Functional Disorders of Memory, J.E. Kilstrom and F.J. Evans (eds.). Hisdale, NJ: Erlbaum, pp. 219–238.

    Google Scholar 

  67. Ryan C, Butters N: (1980) Learning and memory impairment in young and old alcoholics: Evidence for the premature aging hypothesis. Alchoholism 4:288–293.

    CAS  Google Scholar 

  68. Sunderland A, Harris JE, and Gleave JA: (1984) Memory failures in everyday life following severe head injury. J Clin Neuropsychol 6:127–142.

    PubMed  CAS  Google Scholar 

  69. Squire LR: (1986) The neuropsychology of memory dysfunction and its assessment. In Neuropsychological Assessment of Neuropsychiatric Disorders, I. Grant and K.M. Adams (eds.). New York: Oxford University Press, pp. 268–299.

    Google Scholar 

  70. Russell EW: (1975) A multiple scoring method for the assessment of complex memory functions. J Consult Clin Psychol 43:800–809.

    Google Scholar 

  71. Buschke H, Fuld PA: (1974) Evaluating storage, retention, and retrieval in disordered memory and learning. Neurology 11:1019–1025.

    Google Scholar 

  72. Reitan RM, Davison LA (eds.): (1974) Clinical Neuropsychology: Current Status and Applications. New York: Wiley.

    Google Scholar 

  73. Reitan RM, Wolfson D. (1985) The Halstead-Reitan Neuropsychological Test Battery: Theory and Clinical Interpretation. Tucson, AR: Neuropsychology Press.

    Google Scholar 

  74. Grant I, Heaton RR, McSweeny AJ, Adams RM, Timmes, RM. (1982) Neuropsychological finding in hypoxemic chronic obstructive pulmonary disease. Arch Intern Med 142:1470–1476.

    PubMed  CAS  Google Scholar 

  75. Lewis R, Rennick PW: (1979) Manual for the Repeatable Cognitive-Perceptual-Motor Battery. Grosse Pointe Park, MI: Axon Publishing Co.

    Google Scholar 

  76. Lewis R, Kupke T: (1977) The Lafayette Clinic repeatable neuropsychological test battery: Its development and research application. Paper presented at the annual meeting of the Southeastern Psychological Association, Hollywood, Florida.

    Google Scholar 

  77. Gronwall D, Wrightson P: (1981) Memory and information processing after closed head injury. J Neurol Neurosurg Psychiatry 44:889–895.

    PubMed  CAS  Google Scholar 

  78. Dick JPR, Guiloff RJ, Stewart A, Blackstock J, Bielawska C, Paul EA, Marsden CD: (1984) Mini-mental state examination in neurological patients. J Neurol Neurosurg Psychiatry 47: 496–499.

    PubMed  CAS  Google Scholar 

  79. Freeman AM III, Folks DG, Sokol RS, Govier AV, Reves JG, Fleece EL, Hall KR, Zorn GL, Karp RB: (1985) Cognitive function after coronary bypass surgery: Effect of decreased cerebral blood flow. Am J Psychiat 142:110–112.

    PubMed  Google Scholar 

  80. Townes BD, Hornbein TF, Schoene RB, Grant I, Sarnquist RH: (1984) Human cerebral function at extreme altitude. In High Altitude and Man, J.B. West and S. Lahiri (eds.). Bethesda, MD: American Physiological Society, pp. 31–36.

    Google Scholar 

  81. Butcher JN: (1978) Minnesota Multiphasic Personality Inventory. In The Eighth Mental Measurements Yearbook, O.R. Buros (ed.). Highland Park, NJ: Gyphon Press.

    Google Scholar 

  82. Jenkins CD, Stanton BA, Savageau J A, Denlinger P, Klein MD: (1983) Coronary artery bypass surgery: Physical, psychological, social, and economic outcomes six months later. JAMA 250:782–788.

    PubMed  CAS  Google Scholar 

  83. McNair DM, Low M, Droppleman LF. (1981) EITS Manual for the Profile of Mood States. San Diego, CA: Educational and Industrial Testing Service.

    Google Scholar 

  84. Bergner M, Bobbitt R, Center W, Gilson BS: (1981) The Sickness Impact Profile: Development and final revision of a health status measure. Med Care 19:787–805.

    PubMed  CAS  Google Scholar 

  85. Sotaniemi KA: (1982) Prediction of cerebral outcome after extracorporeal circulation. Acta Neurol Scand 66:697–704.

    PubMed  CAS  Google Scholar 

  86. Shida H, Morimoto M, Inokawa K, Ikeda Y, Tsugane J, Yuzuriha H: (1981) Somatic and psychomotor development of children after hypothermic open-heart surgery. Jpn J Surg 11:154–161.

    PubMed  CAS  Google Scholar 

  87. Sotaniemi KA: (1981) The benefits of open-heart surgery as reflected in the EEG. Scand J Thor Cardiovasc Surg 15:205–212.

    CAS  Google Scholar 

  88. Aberg T, Ronquist G, Tyden H, Brunnkvist S, Hultman J, Bergstrom K, Anders L: (1984) Adverse effects on the brain in cardiac operations as assessed by biochemical, psychometric and radiologic methods. J Thorac Cardiovasc Surg 87:99–105.

    PubMed  CAS  Google Scholar 

  89. Fish KJ, Helms KN, Sarnquist FH, van Steennis C, Linet OI, Hilberman M, Mitchell RS, Jamieson SW, Miller DC, Tinklenberg JS: (1987) A prospective, randomized study of the effects of prostacyclin on neuropsychological dysfunction after coronary artery surgery. J Thorac Cardiovasc Surg 93:609–615.

    PubMed  CAS  Google Scholar 

  90. Muraoka R, Yokota M, Aoshima M, Kyoku I, Nomoto S, Kobayashi A, Nakano H, Ueda K, Saito A, Hojo H: (1981) Subclinical changes in brain morphology following cardiac operations as reflected by computed tomographic scans of the brain. J Thorac Cardiovasc Surg 81:364–369.

    PubMed  CAS  Google Scholar 

  91. Henriksen L, Hjelms E, Lindeburgh T (1983) Brain hyperperfusion during cardiac operations. J Thorac Cardiovasc Surg 86:202–208.

    PubMed  CAS  Google Scholar 

  92. Govier AV, Reves JG, McKay RD, Karp RB, Zorn GL, Morawetz RB, Smith LR, Adams M, Freeman AM: (1984) Factors and their influence on regional cerebral blood flow during nonpulsatile cardiopulmonary bypass. Ann Thorac Surg 38:592–600.

    PubMed  CAS  Google Scholar 

  93. Prough DS, Stump DA, Roy RC, Gravlee GP, Williams T, Mills SA, Hinshelwood L, Howard G: (1986) Response of cerebral blood flow to changes in carbon dioxide tension during hypothermic cardiopulmonary bypass. Anesthesiology 64:576–581.

    PubMed  CAS  Google Scholar 

  94. Hendriksen L: (1984) Evidence suggestive of diffuse brain damage following cardiac operations. Lancet 1:816–820.

    Google Scholar 

  95. Taylor KM, Devlin BJ, Mittra SM, Gillan JG, Brannan JJ, McKenna JM: (1980) Assessment of cerebral damage during open-heart surgery—A new experimental model. Scand J Thor Cardiovasc Surg 14:197–203.

    CAS  Google Scholar 

  96. Edgre E, Terent A, Hedstrand U, Ronquist G: (1983) Cerebrospinal fluid markers in relation to outcome in patients with global cerebral ischemia. Crit Care Med 11:4–6.

    Google Scholar 

  97. Aberg T, Ronquist G, Tyden H, Ahlund P, Bergstrom K: (1982) Release of adenylate kinase into cerebrospinal fluid during open-heart surgery and its relation to postoperative intellectual function. Lancet 1:1139–1142.

    PubMed  CAS  Google Scholar 

  98. Aren C, Blomstrand C, Wikkelso C, Radegran K: (1984) Hypotension induced by prostacyclin treatment during cardiopulmonary bypass does not increase the risk of cerebral complications. J Thorac Cardiovasc Surg 88:748–753.

    PubMed  CAS  Google Scholar 

  99. Graham DI: (1977) Pathology of hypoxic brain damage in man. J Clin Path 30 (Suppl.) 11: 170–180.

    CAS  Google Scholar 

  100. Gravlee GP, Hudspeth AS, Toole JF: (1984) Bilateral brachial paralysis from watershed infarction after coronary artery bypass. A report of two cases and review of the predisposing anatomic and physiologic mechanisms. J Thorac Cardiovasc Surg 88:742–747.

    PubMed  CAS  Google Scholar 

  101. Witoszka MM, Tamura H: (1980) Neurological dysfunction and behavior disorders following open-heart surgery. In Psychic and Neurological Dysfunctions After Open-Heart Surgery, H. Speidel and G. Rodewald (eds.). New York: Thieme, pp 76–91.

    Google Scholar 

  102. Stockard JJ, Bickford RG, Schauble JF: (1973) Pressure-dependent cerebral ischemia during cardiopulmonary bypass. Neurology 23:521–529.

    PubMed  CAS  Google Scholar 

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Authors
  1. G. Bashein
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  2. Stephen W. Bledsoe
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  3. Brenda D. Townes
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  4. David B. Coppel
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Editors and Affiliations

  1. University of Colorado, Denver, Colorado, USA

    Mark Hilberman

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© 1988 Martinus Nijhoff Publishing, Boston

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Bashein, G., Bledsoe, S.W., Townes, B.D., Coppel, D.B. (1988). Tools for Assessing Central Nervous System Injury in the Cardiac Surgery Patient. In: Hilberman, M. (eds) Brain Injury and Protection During Heart Surgery. Springer, Boston, MA. https://doi.org/10.1007/978-1-4613-2075-3_7

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