Neuropsychological dysfunction in the absence of structural evidence for cerebral ischemia after uncomplicated carotid endarterectomy.
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.
Heyer
Eric J
EJ
Department of Anesthesiology, Columbia University, New York, New York, USA. ejh3@columbia.edu
DeLaPaz
Robert
R
Halazun
Hadi J
HJ
Rampersad
Anita
A
Sciacca
Robert
R
Zurica
Joseph
J
Benvenisty
Alan I
AI
Quest
Donald O
DO
Todd
George J
GJ
Lavine
Sean
S
Solomon
Robert A
RA
Connolly
E Sander
ES
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