Post-Pump Chorea and Progressive Supranuclear Palsy-Like Syndrome Following Major Cardiac Surgery

Abstract

Background: Post-pump chorea and progressive-supranuclear palsy (PSP)-like syndrome after aortic surgery are 2 distinct movement disorders following major cardiac surgeries.

Cases: We herein report 3 patients with movement disorders that developed after major cardiac surgeries. Two patients developed post-pump chorea after pulmonary endarterectomy, and 1 further case developed PSP-like syndrome after aortic replacement surgery. The 2 conditions share several common aspects. Both are preceded by surgeries that undergo cardiopulmonary bypass and deep hypothermia circulatory arrest procedures. Most cases present with biphasic course. However, post-pump chorea occurs in all age populations after any surgeries that undergo deep hypothermia circulatory arrest, whereas PSP-like syndrome is reported exclusively in the adult population after aortic surgery.

Conclusions: Post-pump chorea and PSP-like syndrome are neurologic complications of major cardiac surgeries that should not be underrecognized. Further reports to establish their common pathogenic mechanism should be encouraged.

Keywords: Post‐pump chorea; cardiopulmonary bypass; deep hypothermia circulatory arrest; progressive supranuclear palsy.

Figure 1

A–C: Case 1. (A) Chest computed tomography (CT) shows pulmonary embolism. (B) Initial T2 and diffusion‐weighted MRI demonstrates high signal intensities of bilateral globus pallidus (white arrows) with diffusion restrictions (white arrowheads). White‐edged box contains apparent diffusion coefficient map. The high signal intensities are normalized 2 weeks thereafter. (C) ¹⁸F‐fluorodeoxyglucose–positron emission tomography demonstrates bilateral putaminal hypometabolism (black arrows). (D–E) Case 2. (D) Chest computed tomography shows pulmonary embolism. (E) MRI taken 3 weeks after the onset of choreoathetosis shows no definite abnormalities. (F–H) Case 3. (F) Chest computed tomography demonstrates thoracic aortic dissection. (G) Initial and followed‐up MRI shows interval brainstem atrophy (red arrowheads). (H) ¹⁸F‐fluorodeoxyglucose–positron emission tomography shows midbrain and anterior cerebellar hypometabolism (black arrowheads). MRI, magnetic resonance imaging.