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(Stroke. 2003;34:1419.)
© 2003 American Heart Association, Inc.

Original Contributions

Cognitive Impairment Is Related to Cerebral Lactate in Patients With Carotid Artery Occlusion and Ipsilateral Transient Ischemic Attacks

Floor C. Bakker, MA; Catharina J.M. Klijn, MD; Aagje Jennekens-Schinkel, PhD; Ingeborg van der Tweel; Jeroen van der Grond, PhD; Alexander C. van Huffelen, MD; Cornelis A.F. Tulleken, MD L. Jaap Kappelle, MD

From the Department of Neurology (C.J.M.K., L.J.K.), Sector of Neuropsychology (F.C.B., A.J.S.), Department of Neurosurgery (C.A.F.T.), Department of Radiology (J.v.d.G.), Department of Clinical Neurophysiology (A.C.v.H.), and University Center for Biostatistics (I.v.d.T.), University Medical Center Utrecht, and the Rudolf Magnus Institute of Neuroscience, Utrecht, the Netherlands.

Correspondence to F.C. Bakker, Department of Neurology, Sector of Neuropsychology, KG 01.327.1, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, Netherlands. E-mail F.Bakker{at}rng.nl

Background and Purpose— Patients with carotid artery occlusion (CAO) and ipsilateral transient ischemic attack (TIA) can have lasting cognitive impairment, despite the recovery of focal neurological deficits. We sought to assess whether cognitive impairment in these patients is associated with hemodynamic compromise and/or impaired cerebral metabolism.

Methods— In 39 consecutive patients with a TIA associated with an angiographically proven occlusion of the carotid artery, we examined (1) cognitive functioning, (2) cerebrovascular reserve capacity of the middle cerebral artery ipsilateral to the CAO as measured by transcranial Doppler ultrasound, and (3) metabolic ratios as measured by ¹H-MR spectroscopy in the centrum semiovale ipsilateral to the symptomatic CAO. Findings were compared with those in healthy control subjects.

Results— As a group, patients were cognitively impaired. Mean CO₂ reactivity and the mean ratio of N-acetyl aspartate to creatine were decreased. In approximately one third of patients, lactate was present in noninfarcted regions. The presence of lactate proved to be a stronger correlate of cognitive impairment than MRI-detected lesions (ß=0.41 versus ß=0.15). Cognitive impairment did not correlate with CO₂ reactivity or the ratio of N-acetyl aspartate to creatine.

Conclusions— This exploratory study in patients with CAO and ipsilateral TIA showed that ¹H-MR spectroscopy–detected lactate in noninfarcted regions is a better indicator of cognitive impairment than MRI-detected lesions. Cognitive impairment did not correlate with CO₂ reactivity.

Key Words: carotid artery occlusion • cerebral ischemia, transient • cerebral metabolism • cognitive disorders • hemodynamics

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				F. C. Bakker, C. J.M. Klijn, J. van der Grond, L. J. Kappelle, and A. Jennekens-Schinkel Cognition and quality of life in patients with carotid artery occlusion: A follow-up study Neurology, June 22, 2004; 62(12): 2230 - 2235. [Abstract] [Full Text] [PDF]