Cognitive functions in patients with stenotic lesions of the great arteries of the head before and after carotid endartectomy
https://doi.org/10.14412/2074-2711-2011-340
Abstract
Objective: to study higher mental functions (HMF) in patients with stenotic lesion of the brachiocephalic arteries (BCA) before and after carotid endarterectomy (CE).
Patients and methods. Prior to and following CE, 97 patients underwent neurological examination, neuropsychological syndrome analysis described by A.R. Luria, evaluation using the Wexler verbal working memory scale, Stroop word-digital test, and Schulte test. BCA ultrasound duplex scanning and cerebral perfusion were made over time.
Results. Preoperative neuropsychological study revealed abnormalities in 98% of the patients. There was most common bilateral frontal dysfunction and deep structural pathology, which were more pronounced in persons above 50 years of age and in the presence of mixed BCA stenosis. Stenosis-associated unilateral parietal and temporal dysfunctions were more frequently registered. Within 30 days after CE, the maximum HMF changes were found in patients having unilateral stenosis. There was ameliorated dysfunction of the structures blood is supplied to which by an operated vessel and the vertebrobasilar system. Poststroke patients were found to have a significant intraoperative HMF reduction in the early rehabilitation period of stroke. The syndromes having common and local mechanisms of development and different topic sites were identified among the short-term and reversible HMF impairments.
Conclusion. Despite heterodirectional HMF changes in the early period after BCA reconstructive operations, the positive cognitive functional changes in all the patients at 30 days of CE confirm the rationale for and efficiency of surgical intervention.
Patients and methods. Prior to and following CE, 97 patients underwent neurological examination, neuropsychological syndrome analysis described by A.R. Luria, evaluation using the Wexler verbal working memory scale, Stroop word-digital test, and Schulte test. BCA ultrasound duplex scanning and cerebral perfusion were made over time.
Results. Preoperative neuropsychological study revealed abnormalities in 98% of the patients. There was most common bilateral frontal dysfunction and deep structural pathology, which were more pronounced in persons above 50 years of age and in the presence of mixed BCA stenosis. Stenosis-associated unilateral parietal and temporal dysfunctions were more frequently registered. Within 30 days after CE, the maximum HMF changes were found in patients having unilateral stenosis. There was ameliorated dysfunction of the structures blood is supplied to which by an operated vessel and the vertebrobasilar system. Poststroke patients were found to have a significant intraoperative HMF reduction in the early rehabilitation period of stroke. The syndromes having common and local mechanisms of development and different topic sites were identified among the short-term and reversible HMF impairments.
Conclusion. Despite heterodirectional HMF changes in the early period after BCA reconstructive operations, the positive cognitive functional changes in all the patients at 30 days of CE confirm the rationale for and efficiency of surgical intervention.
About the Authors
O. V. Gavrilova
Department of Fundamental and Clinical Neurology and Neurosurgery
Russian Federation
Russian Federation
L. V. Stakhovskaya
Department of Fundamental and Clinical Neurology and Neurosurgery;
Research Institute of Cerebrovascular Pathology and Stroke, Russian National Research Medical University
Russian Federation
Russian Federation
S. B. Buklina
N.I. Burdenko Neurosurgery Research Institute, Russian Academy of Medical Sciences
Russian Federation
Russian Federation
D. Yu. Usachev
N.I. Burdenko Neurosurgery Research Institute, Russian Academy of Medical Sciences
Russian Federation
Russian Federation
V. A. Lukshin
N.I. Burdenko Neurosurgery Research Institute, Russian Academy of Medical Sciences
Russian Federation
Russian Federation
A. Yu. Belyaev
N.I. Burdenko Neurosurgery Research Institute, Russian Academy of Medical Sciences
Russian Federation
Russian Federation
V. V. Akhmetov
City Clinical Hospital Twenty
Russian Federation
Moscow
Russian Federation
Moscow
V. I. Skvortsova
Department of Fundamental and Clinical Neurology and Neurosurgery;
Research Institute of Cerebrovascular Pathology and Stroke, Russian National Research Medical University
Russian Federation
Russian Federation
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Review
For citations:
Gavrilova O.V., Stakhovskaya L.V., Buklina S.B., Usachev D.Yu., Lukshin V.A., Belyaev A.Yu., Akhmetov V.V., Skvortsova V.I. Cognitive functions in patients with stenotic lesions of the great arteries of the head before and after carotid endartectomy. Neurology, Neuropsychiatry, Psychosomatics. 2011;3(4):18-22. (In Russ.) https://doi.org/10.14412/2074-2711-2011-340
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