Evaluation of subclinical cerebral injury and neuropsychologic function in patients undergoing carotid endarterectomy.
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.
Falkensammer
Juergen
J
Section of Vascular Surgery, Mayo Clinic Jacksonville, Jacksonville, FL 32224, USA.
Oldenburg
W Andrew
WA
Hendrzak
Andrea J
AJ
Neuhauser
Beate
B
Pedraza
Otto
O
Ferman
Tanis
T
Klocker
Joseph
J
Biebl
Matthias
M
Hugl
Beate
B
Meschia
James F
JF
Hakaim
Albert G
AG
Brott
Thomas G
TG
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
D015415:Biomarkers; D009418:S100 Proteins; D010751:Phosphopyruvate Hydratase