Asymmetric brain edema after cardiac transplantation: cerebroautoregulatory failure and relative hyperperfusion.

Asymmetric brain edema is a rare neurologic complication after cardiovascular surgery. We describe the clinical and imaging features of an asymmetric brain edema syndrome in a 52-year-old man following cardiac transplantation who presented with facial myoclonus and left hemiparesis in the postoperative period. To our knowledge, this is the first case report of asymmetric brain edema syndrome after cardiac transplant and the second following cardiac surgery. Arterial bypass cannula malposition in the ascending aorta or brachiocephalic artery with subsequent cerebral hypoperfusion and subsequent hyperperfusion appears to be the most likely physiologic cause.