Neuropsychological dysfunction in the absence of structural evidence for cerebral ischemia after uncomplicated carotid endarterectomy
Neuropsychological dysfunction in the absence of structural evidence for cerebral ischemia after uncomplicated carotid endarterectomy
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DOI：
10.1227/01.neu.0000197123.09972.ea
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发表时间：
2006-03-01
期刊：
影响因子：
4.8
通讯作者：
Connolly, ES
中科院分区：
文献类型：
--
作者：
Heyer, EJ;DeLaPaz, R;Connolly, ES
目的：神经认知功能障碍已被证明发生在大约25%的患者接受颈动脉内膜切除术（CEA）。尽管如此，人们对这种损伤的机制知之甚少。最近，几个研究小组已经表明，新的扩散加权成像（DWI）阳性病变出现在20%的患者接受CEA。我们调查到什么程度的神经认知功能障碍与新的DWI lesions.METHODS：34例连续接受CEA的患者进行了术前和术后的认知评估与电池的神经心理学测试。所有患者在术后24小时内进行术后磁共振成像。病变显示高信号的DWI和限制扩散的表观扩散系数图，但没有异常高信号的液体衰减反转恢复images.Results：认知功能障碍被认为是在8例（24%）患者。在3例（9%）中观察到新的超急性DWI病变。只有1例（13%）认知功能障碍患者有新的DWI病变。三分之二的新DWI病变发生在没有认知恶化的情况下。认知功能障碍的患者颈动脉阻断时间明显延长。结论：CEA后神经认知功能障碍似乎与新的DWI阳性病变无关。
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.CONCLUSION: Neurocognitive dysfunction after CEA does not seem to be associated with new DWI positive lesions.