title: Evaluation of subclinical cerebral injury and neuropsychologic function in patients undergoing carotid endarterectomy.
abstract: We examined subclinical alterations of cerebral function during carotid endarterectomy (CEA) and predictability of minor cerebral damage by perioperative levels of biochemical markers of brain damage (S100B and neuron-specific enolase [NSE]). Twenty consecutive patients with > or =70% asymptomatic carotid stenosis undergoing elective CEA were enrolled. Pre- and postoperative testing included magnetic resonance imaging (MRI) of the head, a standardized neurological exam, a battery of neuropsychological tests, and measurement of serum levels of S100B and NSE. There were no major ischemic strokes. In one patient, a mild weakness of the contralateral lower extremity was discovered on neurological examination; in another individual, postoperative MRI revealed two new small subcortical lesions without clinical correlate. While S100B increased significantly early after opening of the carotid clamp (p = 0.015), the NSE increase did not reach statistical significance. As a group, participants obtained a significantly higher mean overall neuropsychological score at follow-up testing (p < 0.05). In one patient, a significant decline of cognitive function was observed. This was the only individual to obtain a consistently high S100B and NSE increase. Neuropsychological testing combined with measurements of S100B and NSE may improve sensitivity when assessing subtle cerebral damage following CEA.
authors.affiliation: Section of Vascular Surgery, Mayo Clinic Jacksonville, Jacksonville, FL 32224, USA.
authors.forename: Juergen
authors.initials: J
authors.lastname: Falkensammer
authors.forename: W Andrew
authors.initials: WA
authors.lastname: Oldenburg
authors.forename: Andrea J
authors.initials: AJ
authors.lastname: Hendrzak
authors.forename: Beate
authors.initials: B
authors.lastname: Neuhauser
authors.forename: Otto
authors.initials: O
authors.lastname: Pedraza
authors.forename: Tanis
authors.initials: T
authors.lastname: Ferman
authors.forename: Joseph
authors.initials: J
authors.lastname: Klocker
authors.forename: Matthias
authors.initials: M
authors.lastname: Biebl
authors.forename: Beate
authors.initials: B
authors.lastname: Hugl
authors.forename: James F
authors.initials: JF
authors.lastname: Meschia
authors.forename: Albert G
authors.initials: AG
authors.lastname: Hakaim
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Brott
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001925:Brain Damage, Chronic / Q000175:diagnosis / Q000209:etiology*; D016893:Carotid Stenosis / Q000601:surgery; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology; D004569:Electroencephalography; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D009483:Neuropsychological Tests; D010751:Phosphopyruvate Hydratase / Q000097:blood; D009418:S100 Proteins / Q000097:blood
chemical_list: D015415:Biomarkers; D009418:S100 Proteins; D010751:Phosphopyruvate Hydratase