Neuropsychological dysfunction in the absence of structural evidence for cerebral ischemia after uncomplicated carotid endarterectomy

Neurosurgery
E J HeyerE S Connolly

Abstract

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. 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. 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. Neur...Continue Reading

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Citations

Dec 25, 2009·Neuroradiology·Iris Quasar GrunwaldChristoph M Krick
Apr 25, 2012·Journal of Neurology·Katrin WasserAndreas Kastrup
Jul 21, 2010·Neurosurgery·Matthew O HebbRobert F Spetzler
Oct 22, 2013·Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia·Eric J HeyerE Sander Connolly
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Nov 5, 2013·Annals of Vascular Surgery·Matthew A CorriereDavid A Stump
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Jan 23, 2018·Vascular Specialist International·Laura Casas-HernanzMiquel Aguilar

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