Neuropsychological changes associated with cerebral vascular surgery.

It is proposed that cerebral revascularisation would reduce the risk of a further episode of transient ischaemic attack or completed stroke. This thesis evaluates the psychological benefits of the two neurosurgical procedures of carotid endarterectomy and extracranial to intracranial microrevascularisation. The studies involved 92 patients some of whom were followed up over a period of 24 months and some over a period of 12 months. Approximately half of the patients suffered a transient ischaemic attack and the other half suffered a completed stroke. Patients were treated surgically by the above-mentioned neurosurgical procedures. A group of patients with cerebrovascular symptoms were employed as a control group. In addition patients with peripheral vascular symptoms were used as a second control group to monitor variables that could affect the outcome of surgery. The studies suggest that cerebrovascular disease or cerebrovascular insufficiency can produce functional deficits which are evident in psychological test performance. Cerebral revascularisation does not result in improvement of cognitive function. Factors such as side of lesion, side of surgery, neurological status, and effects of smoking can affect outcome of treatment.