Document Detail

Postcarotid endarterectomy improvement in cognition is associated with resolution of crossed cerebellar hypoperfusion and increase in 123I-iomazenil uptake in the cerebral cortex: a SPECT study.
MedLine Citation:
PMID:  20130400     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The purpose of the present study was to investigate whether resolution of crossed cerebellar hypoperfusion (CCH) and increase in (123)I-iomazenil (IMZ) uptake in the ipsilateral cerebral cortex after carotid endarterectomy (CEA) are associated with postoperative improvement of cognitive function. METHODS: Neuropsychological testing was performed preoperatively and after 1 postoperative month in 79 patients undergoing CEA for ipsilateral internal carotid artery stenosis (>or=70%). Brain perfusion single photon emission computed tomography (SPECT) using N-isopropyl-p-(123)I-iodoamphetamine and (123)I-IMZ SPECT were also performed before and after surgery. Data were analyzed using a three-dimensional stereotaxic region of interest template. RESULTS: Seven patients (9%) showed improvement in postoperative cognitive function. All the 7 patients exhibited both postoperative increase in blood flow in the ipsilateral cerebral cortex and resolution of CCH. Five patients (6%) had a postoperative hemispheric increase in (123)I-IMZ uptake, and cognitive function improved in all of these 5 patients. Analysis by a receiver operating characteristic (ROC) curve was used to estimate the ability to discriminate between patients with and without postoperative cognitive improvement. The area under the ROC curve was significantly greater when analyzing the magnitude of postoperative resolution of CCH (0.991; 95% CI 0.984-1.001) or postoperative hemispheric increase in (123)I-IMZ uptake (0.981; 95% CI 0.972-0.999) when compared with the magnitude of postoperative increase in cerebral blood flow (0.929; 95% CI 0.886-0.971) (p < 0.05). CONCLUSIONS: Resolution of CCH and increase in (123)I-IMZ uptake in the ipsilateral cerebral cortex after CEA is associated with postoperative improvement in cognitive function. These results may indicate that cognitive impairment is related to a state of potentially reversible central benzodiazepine receptor downregulation in the cortex in response to transient ischemic attack or minor stroke.
Kohei Chida; Kuniaki Ogasawara; Kenta Aso; Yasunori Suga; Masakazu Kobayashi; Kenji Yoshida; Kazunori Terasaki; Eiki Tsushina; Akira Ogawa
Publication Detail:
Type:  Journal Article     Date:  2010-01-30
Journal Detail:
Title:  Cerebrovascular diseases (Basel, Switzerland)     Volume:  29     ISSN:  1421-9786     ISO Abbreviation:  Cerebrovasc. Dis.     Publication Date:  2010  
Date Detail:
Created Date:  2010-03-12     Completed Date:  2010-06-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9100851     Medline TA:  Cerebrovasc Dis     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  343-51     Citation Subset:  IM    
Copyright Information:
(c) 2010 S. Karger AG, Basel.
Department of Neurosurgery, Iwate Medical University, Morioka, Japan.
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MeSH Terms
Afferent Pathways / physiopathology
Carotid Artery, Internal / surgery
Carotid Stenosis / psychology,  surgery*
Cerebellum / blood supply*,  physiopathology
Cerebral Cortex / physiopathology,  radionuclide imaging*
Cognition Disorders / etiology,  prevention & control*
Dominance, Cerebral
Endarterectomy, Carotid*
Flumazenil / analogs & derivatives*,  diagnostic use,  pharmacokinetics
Iodine Radioisotopes / diagnostic use*,  pharmacokinetics
Ischemia / physiopathology*,  radionuclide imaging
Middle Aged
Neuropsychological Tests
ROC Curve
Receptors, GABA-A / metabolism*
Tomography, Emission-Computed, Single-Photon*
Treatment Outcome
Reg. No./Substance:
0/Iodine Radioisotopes; 0/Receptors, GABA-A; 127396-36-5/iomazenil; 78755-81-4/Flumazenil

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