Motor Speech Deficit Following Carotid Endarterectomy

Abstract

Stroke as a complication of carotid endarterectomy has been extensively reviewed. Considerably less attention has been directed to local injuries of the cranial nerves and their branches. Verta, Hertzer, Imparato, DeWeese, and Matsumoto have reported experience with these injuries. DeWeese found a 9.7% rate of cranial nerve injury, while in Hertzer's series, 15% of patients had nerve dysfunction in the early postendarterectomy period. In 1980, Liapis in a preliminary report found that when postoperative examination was supplemented by detailed evaluation by speech pathologists, the incidence of early abnormalities reached 27%. The purpose of this study was to expand upon Liapis' early observation and to clarify the contribution of the speech pathologists in identifying cranial nerve dysfunctions, specifically those resulting in motor speech abnormalities, following carotid endarterectomy.

Pharyngeal function after carotid endarterectomy

“…This has been reversible in all cases [3]. Similar frequencies have been found in other series [1][2][3][4][5][6][7][8]. Although cranial nerve injury occurs frequently, clinical symptoms of pharyngeal dysfunction are often vague and may therefore be underestimated.…”

“…Earlier studies of cranial nerve complications of Carotid endarterectomy have tbcused on damage to the following nerves: hypoglossal, glossophar.Yngeal, recurrent laryngcal, superior laryngeal, faCial, great auricular, and cervical sympathetic trunk [1][2][3][4][5][6][7][8][9]. Nerve fibers to the pharynx derive from the main vagus trunk just inferior to the nodose ganglion.…”

Incidence, outcomes, and effect on quality of life of cranial nerve injury in the Carotid Revascularization Endarterectomy versus Stenting Trial

“…While the SF-36 may not be sensitive enough to detect the degree of disability related to CNI, it was highly sensitive to detecting disability due to stroke in CREST. 243 The Likert scales which assess more disease specific outcomes did show a negative impact on the difficulty eating/swallowing measurement at both the 2-week and 1-month assessment. At 1-year, this difference was no longer significant.…”

“…10–13 In studies where patients underwent detailed otolaryngological examination pre- and post-operatively to evaluate cranial nerve function, injury was found to occur following 11.5% to39% of operations. 2,3,9,14,15 In contrast, two recent large series using the usual clinical criteria alone found an incidence of 5.5 and 5.6%. 16, 17 The majority of these injuries resolve within a few weeks but the neurologic deficit can be shown to be persistent in as high as 7 – 12% of patients depending on the depth of scrutiny.…”

Risk-Benefit Aspects of Surgery for Asymptomatic Carotid Artery Stenosis

“…The remainder were identified following a detailed examination. Evans et al 52 reported similar findings. In their study however, the incidence of identified cranial nerve injury increased to 39% when a speech pathologist was added to the examining team.…”