title: Deficits of hand coordination and laterality of carotid endarterectomy.
abstract: OBJECTIVE
  Neurocognitive performance is used to assess multiple cognitive domains, including motor coordination, before and after carotid endarterectomy (CEA). Although gross motor strength is impaired with ischemia of large cortical areas or of the internal capsule, the authors hypothesize that patients undergoing CEA demonstrate significant motor deficits of hand coordination contralateral to the operative side, which is more clearly manifest in the nondominant hand than in the dominant hand with ischemia of smaller cortical areas.
  
  
  METHODS
  The neurocognitive performance of 374 patients was evaluated with a battery of neuropsychometric tests. Both asymptomatic and symptomatic patients undergoing CEA were included. The authors evaluated the patients' dominant and nondominant hand performance on the Grooved Pegboard test, a test of hand coordination, to demonstrate their functional laterality. Neurocognitive dysfunction was evaluated as the difference in performance before and after CEA according to group-rate and event-rate analyses. The z scores were generated for all tests using a reference group of patients who were having simple spine surgery. Dominant and nondominant motor coordination functions were evaluated as raw scores and as calculated z scores.
  
  
  RESULTS
  According to event-rate analysis, significantly more patients undergoing CEA of the opposite carotid artery demonstrated nondominant than dominant hand deficits of coordination (41.2% vs 26.4%, respectively, p = 0.02). Similarly, according to group-rate analysis, in patients undergoing CEA of the opposite carotid artery, raw difference scores from the Grooved Pegboard test reflected greater nondominant than dominant hand deficits of coordination (21.0 ± 54.4 vs 9.7 ± 37.0, respectively, p = 0.02).
  
  
  CONCLUSIONS
  Patients undergoing CEA of the opposite carotid artery are more likely to demonstrate nondominant than dominant hand deficits of coordination because of greater dexterity in the dominant hand before surgery.
authors.affiliation: Departments of 1 Anesthesiology.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Heyer
authors.forename: Kaitlin A
authors.initials: KA
authors.lastname: Mallon
authors.forename: Joanna L
authors.initials: JL
authors.lastname: Mergeche
authors.forename: Yaakov
authors.initials: Y
authors.lastname: Stern
authors.forename: E Sander
authors.initials: ES
authors.lastname: Connolly
mesh_terms: D000368:Aged; D015331:Cohort Studies; D016894:Endarterectomy, Carotid / Q000009:adverse effects* / Q000523:psychology; D005260:Female; D007839:Functional Laterality; D006225:Hand / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011183:Postoperative Complications / Q000503:physiopathology* / Q000523:psychology; D011597:Psychomotor Performance / Q000502:physiology; D016896:Treatment Outcome
keywords: CEA = carotid endarterectomy; carotid endarterectomy; cerebrovascular disease/stroke; laterality; motor dysfunction; vascular disorders