Résumé
BACKGROUND: Impairment of cognitive function is often present in patients with carotid artery stenosis but the details of this dysfunction have rarely been reported. Our purpose was to elucidate the cognitive dysfunction in patients with unilateral severe carotid stenosis using comprehensive neuropsychological testing, and also to identify the specific underlying clinical and radiological factors. METHODS: We analyzed the results of neuropsychological testing, the clinical history, and MR findings in 16 consecutive patients with angiographically proven severe (70-99%) stenosis of the extra cranial internal carotid artery (ICA). Cognitive functions were examined using the Seoul Neuropsychological Screening Battery and the Neglect Battery. We excluded patients with cortical infarction and those with contra lateral ICA occlusion or severe stenosis. RESULTS: Our comprehensive neuropsychological testing revealed obvious cognitive deficits in all patients with unilateral severe ICA stenosis, the most common being frontal executive impairment. The mean cognitive score on the memory test was also significantly lower in patients with symptomatic ICA stenosis than in asymptomatic patients (29.33+/-10.98, mean+/-SD, p < 0.05). The total score on the global cognitive test was significantly lower in patients with an ischemic lesion on MRI than in no lesion patients (113.23+/-34.78, p < 0.05). The presence of symptoms related to the ICA stenosis was related to cognitive dysfunction even when there were no ischemic lesions on MRI. SPECT revealed ipsilateral cortical hypoperfusion in 9 of 12 patients (75%). CONCLUSIONS: Cognitive deficits are common in patients with unilateral severe ICA stenosis. Our findings suggest that an additional mechanism beyond the structural lesion such as chronic hypoperfusion may affect cognitive function in patients with high-grade ICA stenosis.
Sujets)
Humains , Artère carotide interne , Sténose carotidienne , Sténose pathologique , Infarctus , Imagerie par résonance magnétique , Dépistage de masse , Mémoire , Tests neuropsychologiques , Séoul , Tomographie par émission monophotoniqueRésumé
In highly selected patients with acute internal carotid artery (ICA) steno-occlusion, prompt restoration might rescue a large ischemic penumbra. We report a 73-year-old man with left hemiparesis, which aggravated with the development of cortical symptoms. MRI & MRA revealed right ICA steno-occlusion and perfusion-diffusion mismatch. The patient underwent emergent carotid endarterectomy and showed clinical improvement without significant complications. The follow-up MRI showed improved perfusion without a new lesion.
Sujets)
Sujet âgé , Humains , Artère carotide interne , Sténose carotidienne , Urgences , Endartériectomie carotidienne , Études de suivi , Imagerie par résonance magnétique , Parésie , Perfusion , Accident vasculaire cérébralRésumé
In highly selected patients with acute internal carotid artery (ICA) steno-occlusion, prompt restoration might rescue a large ischemic penumbra. We report a 73-year-old man with left hemiparesis, which aggravated with the development of cortical symptoms. MRI & MRA revealed right ICA steno-occlusion and perfusion-diffusion mismatch. The patient underwent emergent carotid endarterectomy and showed clinical improvement without significant complications. The follow-up MRI showed improved perfusion without a new lesion.