Neurological injury after cardiac surgery is a devastating complication associated with increased morbidity and mortality. While stroke, seizures, delirium, and cognitive decline exhibit distinct features, they share common underlying etiology and pathophysiology. Emboli, hypoperfusion, and inflammation are thought to be the main contributors to cerebral injury during these procedures. Mitigating the risk of such complications involves optimizing arterial cannulation, cardiopulmonary bypass design and managing temperature, hemodynamic, and glucose levels effectively. Despite significant investigation, the optimal pharmacologic approaches for neuroprotection remain uncertain. Further research is needed to determine the most effective strategies for managing modifiable risk factors, ultimately leading to improved outcomes in the cardiac surgical population.