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

Eric J. Heyer, Robert DeLapaz, Hadi J. Halazun, Anita Rampersad, Robert Sciacca, Joseph Zurica, Alan I. Benvenisty, Donald O. Quest, George J. Todd, Sean Lavine, Robert A. Solomon, E. Sander Connolly

Research output: Contribution to journalArticlepeer-review

80 Scopus citations

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.

Original languageEnglish
Pages (from-to)474-479
Number of pages6
JournalNeurosurgery
Volume58
Issue number3
DOIs
StatePublished - Mar 2006
Externally publishedYes

Keywords

  • Apparent diffusion coefficient
  • Carotid endarterectomy
  • Diffusion weighted imaging
  • Neuropsychological testing
  • Outcome magnetic resonance imaging

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