Ogasawara Kuniaki, Inoue Takashi, Kobayashi Masakazu, Fukuda Takeshi, Komoribayashi Nobukazu, Saitoh Hideo, Yamadate Keiko, Ogawa Akira
Department of Neurosurgery, Iwate Medical University, Morioka, Iwate 020-8505, Japan.
Surg Neurol. 2006 Jun;65(6):577-80; discussion 580-1. doi: 10.1016/j.surneu.2005.07.011.
Neuropsychological testing detects cognitive impairment in 20% to 30% of patients after carotid endarterectomy (CEA).
A 51-year-old man with asymptomatic right cervical internal carotid artery (ICA) stenosis underwent a CEA. Intraoperative transcranial regional cerebral oxygen saturation monitoring revealed ischemia in the right cerebral hemisphere during ICA clamping and transient hyperemia subsequent to ICA declamping. The patient recovered without the appearance of new neurologic deficits. Brain single-photon emission computed tomography performed immediately after CEA showed a decrease in cerebral blood flow in the right cerebral hemisphere. Diffusion-weighted magnetic resonance imaging showed no new abnormal findings. Positron emission tomography performed 2 months after surgery revealed decreased cerebral metabolic rate of oxygen in the right cerebral hemisphere, and neuropsychological testing demonstrated a decline in performance IQ relative to preoperative levels.
Intraoperative ischemia and postischemic delayed hypoperfusion in CEA can impair cognition even in the absence of development of postoperative neurologic deficit.
神经心理学测试在颈动脉内膜切除术（CEA）后20%至30%的患者中检测到认知障碍。
一名51岁无症状右颈内动脉（ICA）狭窄男性接受了CEA手术。术中经颅局部脑氧饱和度监测显示，在ICA夹闭期间右大脑半球缺血，ICA松开后出现短暂性充血。患者康复，未出现新的神经功能缺损。CEA术后立即进行的脑单光子发射计算机断层扫描显示右大脑半球脑血流量减少。弥散加权磁共振成像未显示新的异常发现。术后2个月进行的正电子发射断层扫描显示右大脑半球脑氧代谢率降低，神经心理学测试表明操作智商相对于术前水平有所下降。
CEA术中缺血和缺血后延迟性低灌注即使在未出现术后神经功能缺损的情况下也会损害认知。
