Neuropsychological Dysfunction in the Absence of Structural Evidence for Cerebral Ischemia after Uncomplicated Carotid Endarterectomy

Author:

Heyer Eric J.1,DeLaPaz Robert2,Halazun Hadi J.3,Rampersad Anita3,Sciacca Robert4,Zurica Joseph3,Benvenisty Alan I.5,Quest Donald O.6,Todd George J.5,Lavine Sean6,Solomon Robert A.6,Connolly E Sander7

Affiliation:

1. Departments of Anesthesiology and Neurology, Columbia University, New York, New York

2. Department of Radiology, Columbia University, New York, New York

3. Department of Anesthesiology, Columbia University, New York, New York

4. Department of Medicine, Columbia University, New York, New York

5. Division of Vascular Surgery,Department of Surgery, Saint Luke's Roosevelt Hospital, New York, New York

6. Department of Neurological Surgery, Columbia University, New York, New York

7. Department of Neurological Surgery and Neurology, Columbia University, New York, New York

Abstract

Abstract OBJECTIVE: Neurocognitive dysfunction has been shown to occur in roughly 25% of patients undergoing carotid endarterectomy (CEA). Despite this, little is known about the mechanism of this injury. Recently, several groups have shown that new diffusion weighted imaging (DWI)-positive lesions are seen in 20% of patients undergoing CEA. We investigated to what degree neurocognitive dysfunction was associated with new DWI lesions. METHODS: Thirty-four consecutive patients undergoing CEA were subjected to pre- and postoperative cognitive evaluation with a battery of neuropsychological tests. Postoperative magnetic resonance imaging was performed in all patients within 24 hours of surgery. Lesions that showed high signal on DWI and restricted diffusion on apparent diffusion coefficient maps but no abnormal high signal on the fluid-attenuated inversion recovery images were considered hyperacute. RESULTS: Cognitive dysfunction was seen in eight (24%) patients. New hyperacute DWI lesions were seen in three (9%). Only one (13%) of the patients with cognitive dysfunction had a new DWI lesion. Two thirds of the new DWI lesions occurred in the absence of cognitive deterioration. Patients with cognitive dysfunction had significantly longer carotid cross-clamp times. CONCLUSION: Neurocognitive dysfunction after CEA does not seem to be associated with new DWI positive lesions.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Clinical Neurology,Surgery

Reference17 articles.

1. Collaborators NASCET: Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis,1991

2. Serum S100B protein levels are correlated with subclinical neurocognitive declines after carotid endarterectomy;Connolly;Neurosurgery,2001

3. CT and diffusion-weighted MR imaging in randomized order: Diffusion-weighted imaging results in higher accuracy and lower interrater variability in the diagnosis of hyperacute ischemic stroke;Fiebach;Stroke,2002

4. Clinical relevance of intraoperative embolization detected by transcranial Doppler ultrasonography during carotid endarterectomy: A prospective study of 100 patients;Gaunt;Br J Surg,1994

5. A controlled prospective study of neuropsychological dysfunction following carotid endarterectomy;Heyer;Arch Neurol,2002

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3