CNS dysfunction is a major concern in cardiac surgery, contributing significantly to patient morbidity and mortality. Extensive research has reaffirmed that individuals may face unwanted CNS complications, which frequently surface after the surgical intervention. Postoperative factors contribute to about 20% of CNS complications, but these issues usually emerge after surgery, not during the procedure itself. Instead, they are first recognized during hospitalization, particularly in the intensive care unit (ICU), where vigilant monitoring occurs. Two compelling approaches can be taken to classify postoperative CNS injuries in cardiac surgery patients. The first is clinical, distinguishing between type I and type II disorders, while the second is time-based, distinguishing between early- and late-onset difficulties. Numerous risk factors can heighten the likelihood of these complications. Early risk factors include advanced age, elevated preoperative creatinine levels, a history of prior neurological events, prolonged cardiopulmonary bypass times, and female gender. In contrast, delayed risk factors encompass a history of neurological events, diabetes mellitus, unstable angina, previous cerebrovascular diseases, the necessity for inotropic support, and postoperative atrial fibrillation. Aortic atherosclerosis is an acute and chronic risk factor, adding to the situation’s complexity. The mechanisms behind CNS complications can be elegantly organized into five primary categories: patient-related factors, intraoperative surgical issues, anesthetic challenges during surgery, extracorporeal circulation (ECC) complications, and those arising in the postoperative period. Each category presents its potential contributors, illustrating the multifaceted nature of these complications. To counteract these challenges, a range of prevention strategies is employed, including pharmacologic neuroprotection and refined techniques related to cardiopulmonary bypass (CPB). Innovative and traditional technologies are harnessed to enhance CNS outcomes, ensuring patients can navigate their recovery with the utmost care and support.