• E S Connolly, C J Winfree, A Rampersad, R Sharma, W J Mack, J Mocco, R A Solomon, G Todd, D O Quest, Y Stern, and E J Heyer.
• Department of Neurological Surgery, The Neurological Institute, Columbia University College of Physicians and Surgeons, 710 West 168th Street, New York, NY 10032, USA. esc5@columbia.edu
• Neurosurgery. 2001 Nov 1; 49 (5): 1076-82; discussion 1082-3.

ObjectiveCarotid endarterectomy (CEA) is an effective means of stroke prevention among appropriately selected patients; however, neuropsychometric testing has revealed subtle cognitive injuries in the early postoperative period. The purpose of this study was to establish whether serum levels of two biochemical markers of cerebral injury were correlated with postoperative declines in neuropsychometric test performance after CEA.MethodsFifty-five consecutive patients underwent a battery of neuropsychometric tests 24 hours before and 24 hours after elective CEA. Two patients were excluded because of postoperative strokes. The pre- and postoperative serum levels of S100B protein and neuron-specific enolase for injured patients, defined as those who exhibited significant declines in neuropsychometric test performance (n = 12), were compared with the levels for uninjured patients (n = 41).ResultsThere were no significant differences in the baseline S100B levels for the two groups. Injured patients exhibited significantly higher S100B levels, compared with uninjured patients, at 24, 48, and 72 hours after surgery (P < 0.05). There were no significant differences in neuron-specific enolase levels for injured and uninjured patients at any time point.ConclusionThese data suggest that subtle cerebral injuries after CEA, even in the absence of overt strokes, are associated with significant increases in serum S100B but not neuron-specific enolase levels. Analyses of earlier time points in future studies of subtle cognitive injuries and biochemical markers of cerebral injury after CEA may be revealing.

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