FUNCTIONAL NEUROMARKERS OF POST-TRAUMATIC STRESS DISORDER (PTSD) IN A MAJOR ISCHEMIC STROKE SURVIVOR AFTER CAROTID ENDARTERECTOMY (CEA) REVASCULARIZATION

Abstract

The aim of this study was to test the hypothesis of developing Post-Traumatic Stress Disorder (PTSD) in a major right-hemisphere ischemic brain stroke survivor half a year after CEA revascularization, with the use of Event Related Potentials (ERPs). He was in a serious condition and had limited consciousness. Therefore, the doctor informed the patient's wife about the possibility of sudden death. The patient heard this information and remembered it, which was one of the main causes of the development of PTSD. On the basis of previous research amplitudes of P3 ERP, components elicited in the cued GO/NOGO tasks have been chosen as the candidate for PTSD neuromarkers . A 44-year-old patient had a major ischemic brain stroke while sizeable atherosclerotic plaque causing critical stenosis of the internal carotid artery in Angio-CT was dioscovered. The patient was urgently operated on using CEA. After the operation he had the opportunity to see the removed plaque which had been the cause of his stroke. Despite the positive postoperative recovery, half a year later, the patient began to complain of flashbacks, anxiety, trouble in falling and staying asleep, difficulty in concentration, a loss of interest. For the diagnosis of PTSD we used Checklist Specific for a stressor (PCL-S). Additionally we used Checklist according to the Diagnostic Statistical Manual-5 (DSM-5) classification, and the patient met the PTSD criteria. The cognitive profile of the patient was measured with the use of the Wechsler Memory Test – III (WMS-III). Subsequently, the patient participated in the cued GO/NOGO task (Kropotov, 2009) with a recording 19-channel EEG. The P3 GO and NOGO waves in this task were found to be significantly smaller at p<0.01 in comparison to a group of healthy control subjects of the same age (N=23) taken from the Human Brain Institute (HBI) normative database (https://www.hbimed.com/). The pattern of this neuromarker in our patient corresponds to the ERPs pattern found in PTSD patients. The ERPs in a GO/NOGO task can be used in the assessment of the functional brain changes induced by chronic PTSD.