Сlinical and neurophysiological estimation of cognitive function in patients with chronic cerebral ischemia in a period of recovery after surgery

Abstract

Objective – to estimate the peculiarities of the cognitive function disorders and cognitive evoked potentials (CEP) changes in patients with cerebrovascular deseasis (CVD) in post-operative period and period of recovery.Methods and subjects. 42 patients with chronic cerebral circulation impairment were examined. The patients were operated about the hemodynamic significantly stenosys in internal carotid or/and vertebral artery. The first clinical group included 20 patients, who had acute ischemic stroke; the second group comprised 22 patients without data on ischemic stroke in anamnesis. The methods used: clinical, neurological; neuropsychological testing (NPT), MRI, ultrasound study of the cerebral blood flow, EEG mapping, CEP P300.Results. All studies were conducted in the period of recovery 6 months – 2 years after operation: carotid endarterectomy (14), endovascular angioplasty with stenting (12). Positive changes in blood flow in the area of stenosis, and in the affected intracranial artery and its branches were observed after surgical removal of stenosis. As evidence of cognitive impairment using the results of the NPT decrease by 1.5 σ or more, as a sign of slowing of mental processes – significant increase of the latent period of P300 to 2 σ or more, a significant reduction in the amplitude and increase asymmetry of these indicators. It confirms the correlation of negative effect on the NPT-CEP indicators and next factors: elderly age, decreased blood flow in the proximal segments of the middle cerebral artery by more than 20% of the age norms, absence (significant decrease) in reserve capacity of cerebral blood flow, site of the lesion in the right hemisphere, the presence of seizures.Conclusions. Complex methodology of NTP-CEP allows to educe violations of cognitive functions for patients with CVD in the dynamics of surgery treatment and to control renewal.