title: Neuropsychological dysfunction in the absence of structural evidence for cerebral ischemia after uncomplicated carotid endarterectomy.
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.
  
  
  CONCLUSIONS
  Neurocognitive dysfunction after CEA does not seem to be associated with new DWI positive lesions.
authors.affiliation: Department of Anesthesiology, Columbia University, New York, New York, USA. ejh3@columbia.edu
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Heyer
authors.forename: Robert
authors.initials: R
authors.lastname: DeLaPaz
authors.forename: Hadi J
authors.initials: HJ
authors.lastname: Halazun
authors.forename: Anita
authors.initials: A
authors.lastname: Rampersad
authors.forename: Robert
authors.initials: R
authors.lastname: Sciacca
authors.forename: Joseph
authors.initials: J
authors.lastname: Zurica
authors.forename: Alan I
authors.initials: AI
authors.lastname: Benvenisty
authors.forename: Donald O
authors.initials: DO
authors.lastname: Quest
authors.forename: George J
authors.initials: GJ
authors.lastname: Todd
authors.forename: Sean
authors.initials: S
authors.lastname: Lavine
authors.forename: Robert A
authors.initials: RA
authors.lastname: Solomon
authors.forename: E Sander
authors.initials: ES
authors.lastname: Connolly
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000175:diagnosis / Q000523:psychology*; D016893:Carotid Stenosis / Q000175:diagnosis / Q000523:psychology / Q000601:surgery; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology / Q000523:psychology*; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests