Mean age was 52.5 9.6 years and 91% were women (57% were post-menopausal). grading of atherosclerosis and at which site, has to be further clarified and addressed by future studies of larger sample volumes. J Am Geriatr Soc. More importantly, however, our study showed also several limitations. That is in particular striking regarding VAD. The mini-mental state examination and Montreal cognitive assessment in persons with mild subacute stroke: relationship to functional outcome. Turm von London Deutsche Version. 2011;35(5):1291301. The PTSS-14 was developed by Twigg et al. Spontaneous dissections have been reported. Not applicable. The data suggest that posttraumatic stress symptoms are of significant importance for the QOL after VAD. WebThe vertebral arteries are part of the circulatory system. The diagnosis of VAD was based on typical findings such as intramural hematoma on axial cervical MRI, or string sign or long tapering stenosis on computer tomography (CT) / MRI angiography in accordance to Rodallec et al. BMC Neurol 19, 312 (2019). Source Reference: Markus H, et al "Antiplatelet therapy vs anticoagulation therapy in cervical artery dissection: the Cervical Artery Dissection in Stroke Study Your vertebral artery runs along the back of your neck and supplies your brain and spine with oxygen-rich blood. Disabil Rehabil. (2002) [5], mean age 50years, (2) posttraumatic stress symptoms as significant predictor for reduced SS-QOL Speck et al. J Clin Neurol. The challenging main consequence from our study regarding this older age group of VAD patients might be therefore for the treating physician to make the right decision: When to consider (re-)dissection stroke and when to consider neuropsychiatric sequelae, for example. They argued that a systematic follow-up of the vascular lesions may induce anxiety both in patients and physicians and lead to inappropriate treatments. An artery tear, also called a dissection, occurs when layers of the interior arterial walls separate. Zubin J, Spring B. Likewise, in concordance with the literature [5, 6, 36], functional outcome was good (mRS02) in the majority of patients (81.25%). Williams LS, Weinberger M, Harris LE, Biller J. On rare occasions, this can lead to stroke. Five-point test. Both conditions fit if someone is suffering from a spontaneous artery dissection as well as subarachnoid hemorrhage in contrast to ischemic stroke caused by vascular risk factors which can be treated. The aim of this study was therefore as follows: (1) to evaluate the characteristics of patients after VAD with special focus on those with bad quality of life despite good functional outcome in comparison with positive and negative control patients in a prospective comparative study design (2); to identify contributing factors to quality of life after VAD, considering neurological, cognitive, and psychological variables (3); to identify the predictive factors for quality of life after VAD. Vertebral artery dissection (VAD) may cause cerebral ischemia and impair quality of life (QOL) despite of good functional outcome. Most patients achieved good QOL (SS-QOL4.0) at 6months follow-up in group I (68.4%) and even better in group M (87.5%) in contrast with group D (46.9%) (Table2). On rare occasions, this can lead to stroke. Eur J Neurol. 1 It is an important cause of stroke in the young, particularly in otherwise healthy patients without traditional vascular risk factors. Debette S, Leys D. Cervical-artery dissections: predisposing factors, diagnosis, and outcome. CADISS Trial Investigators. Healthcare providers can often diagnose a vertebral artery dissection with a computed tomography (CT) scan or CT angiography. Google Scholar. In general, various factors have been shown to influence the QOL of patients after stroke without dissection, including post-stroke anxiety [9], depression [10] and cognitive impairment [11]. Hemorrhagic stroke was found to result in a lower survival rate or lower level of functionality than ischemic stroke. Testbatterie zur Aufmerksamkeitsprfung (TAP) Version 2.2. A total score11 out of 14 items corresponds to a pathological result, a score between 8 and 10 means a suspect result. We thank Dr. Werner Wosniok from the Institute of Statistics at the University of Bremen, Bremen, for his statistical advice. Furthermore, it may sufficiently explain the predominant impairments of psychosocial QOL domains after VAD. They included benign paroxysmal positional vertigo in 40%, vestibular neuritis in 24%, vestibulocochlear irritation in 4%, Schwannoma in 4%, suspected somatoform dizziness in 8% and nonspecific dizziness of unknown origin in 16%. Cervical artery dissection--clinical features, risk factors, therapy and outcome in 126 patients. Measurements of acute cerebral infarction: a clinical examination scale. Regensburger Wortflssigkeitstest. No further differences were found in the other domains. Clinical monitoring should address this topic to make timely treatment possible. (2014) [46], mean age 44.8years. The cerebellar cognitive profile. Tang WK, Lau CG, Mok V, Ungvari GS, Wong KS. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. 2013;80(21):19507. It comprised standardized self-rating protocols for neurostatus (mRS), stroke specific QOL and posttraumatic stress symptoms, and in addition open questions for the clinical course. Differences in reduced neurostatus at baseline (NIH-SS on admission)(p=0.042) in subgroup D (mRS 02) SS-QOL3.9 vs. SS-QOL4.0 and higher grade of white matter lesions (WML)(p=0.042) in subgroup I (mRS 02) SS-QOL3.9 vs. SS-QOL4.0 were not significant after correction of cumulative alpha-error. Neurological outcome and quality of life after stroke due to vertebral artery dissection. Its more common in people younger than 45. Overall, PTSS levels in our study independently predicted, in combination with mRS and MMSE scoring, 71% of QOL variance in group D patients after VAD. It can also lead to swelling (dilation) of the artery. Med Hypotheses. WebScore: 4.2/5 (61 votes) . Auflage. Grond-Ginsbach C, Metso TM, Metso AJ, Pezzini A, Tatlisumak T, Hakimi M, et al. Mean MoCA values of group D (24.24) and I (24.86), however, displayed slightly pathological scores. 2009;8(7):66878. Tourette syndrome is a childhood onset neuropsychiatric disorder characterized by involuntary or urge-driven motor and vocal tics. Exclusion criteria were as follows: (1) VAD due to severe trauma - in contrast to conventionally as spontaneous labeled dissection due to minor prior cervical trauma which should be better termed mechanical trigger event according to Engelter et al. Fischer U, Ledermann I, Nedeltchev K, Meier N, Gralla J, Sturzenegger M, et al. Thirty-one of 62 study participants completed 18.922.72months after discharge four tests of attention and memory function. Traenka C, Jung S, Gralla J, Kurmann R, Stippich C, Simonetti BG, et al. It generates 12 domain-related scores and a total score. The variance of total QOL was determined by neurological, neurocognitive and psychological predictive factors. Even if WML predominated in groups D and I compared to stroke mimics, they showed no significant inter-group difference. 88.2% of patients with VAD suffered from acute cerebral ischemia. SS-QOL scores at follow-up varied among subgroups as demonstrated in a subgroup analysis stratified for good functional outcome (mRS 02) plus good quality of life (SS-QOL4.0) versus good functional outcome (mRS 02) plus bad quality of life (SS-QOL3.9). When starting the present study, however, the knowledge about the putative contributing role of cognitive as well as psycho-affective factors to QOL in VAD patients was lacking. Trial of org 10172 in acute stroke treatment. Preceding correlation analyses in this study yielded significant correlations in between all neurocognitive measures such as MMSE, MoCA, and CCS at baseline and likewise in between both neurostatus measures such as NIH-SS on admission and mRS at baseline. (https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-019-1541-x), Visitation, mask requirements and COVID-19 information. Three cohorts of consecutive patients were included in the study for the purpose of comparison: group D (dissection) as the main group comprised patients with first-time spontaneous vertebral artery dissection (VAD) of at least one vertebral artery, group I (ischemia) as a positive control group consisted of patients with acute cerebral ischemia such as stroke or transient ischemic attack (TIA) of the posterior circulation due to any other cause than dissection, and group M (mimics) was chosen as a negative control group of stroke mimics of the posterior circulation. (2002) [5] and Fischer et al. 1983;67(6):36170. Traenka et al. Vertebral artery dissection (VAD) is increasingly identified as a cause of ischemic stroke in young adults. Painting a ceiling with your neck in an extended position for a long time. CTA, MRI, and Ahl et al. Secondary exclusion due to defined criteria decreased the number of baseline patients of group D to 34 and group M to 25. WebA vertebral artery dissection is not what youd expect at 35 years young. 2008;52(2):2028. 3rd ed. The mean group values of single tests as well as of CCS showed at least clear trends of stronger cognitive impairments in group D and group I patients than stroke mimics regarding the following cognitive domains: Divided and selective attention (TAP), combined attention and executive function (TMT A and B), mental rotation (LPS-7), and spatial cognitive function (FPT). It can affect blood flow, putting you at risk for life-threatening complications. Vertebral artery dissection: presenting findings and predictors of outcome. Cervicocerebral artery dissection (CAD) is an important and under-recognized cause of strokes in young and middle-aged patients. 1993;24(1):3541. You can still exercise but should avoid the following: Vertebral artery dissection occurs when a tear forms in one of the blood vessels running up the back of your neck. Kwa VI, Limburg M, de Haan RJ. MoCA, to our best knowledge, was used in our study for the first time in VAD patients. Bruggimann L, Annoni JM, Staub F, von Steinbuchel N, Van der Linden M, Bogousslavsky J. Because of the great Correspondence to The clinical application of the biopsychosocial model. (2014) [46]. Vertebral artery dissection (VAD) is an increasingly recognized cause of stroke in patients younger than 45 years. Clinical prediction of functional outcome after ischemic stroke: the surprising importance of periventricular white matter disease and race. (2005) [41], for example, noted a correlation of the degree of WML with cognitive decline. Symptomatic intracranial vertebral artery atherosclerotic stenosis (>/=70%) with concurrent contralateral vertebral atherosclerotic diseases in 88 patients treated with the intracranial stenting. For the neuropsychological testing at baseline the longer established Mini-Mental State Examination (MMSE) [15] and the more sensitive Montreal Cognitive Assessment (MoCA) [23] were performed as cognitive screening tests in their German versions. Therefore, pathological alterations might have been either too subtle for detection, the applied neuropsychological tests not sensitive enough, or the study cohorts too heterogenous. Acta Psychiatr Scand. Neurology. There were significant more neurological impairments at baseline, that are higher scores of mRS for functional disability or NIH-SS for neurological deficit, in group D as well as I patients with ischemic stroke lesions compared to stroke mimics. Previous Furthermore, by multiple regression analysis, they were no predictors of QOL variance of VAD patients at follow-up. CAS However, you may be at risk for future dissections. The authors declare that they have no competing interests. Rodallec MH, Marteau V, Gerber S, Desmottes L, Zins M. Craniocervical arterial dissection: spectrum of imaging findings and differential diagnosis. Jokinen et al. The risk of dying can be as high as 1% to 3% per hour until the patient gets treatment. Follow-up group comparison of variables of paired samples for changes over time was performed by using the Wilcoxon-test. Although specific information about overall life expectancy after aortic dissection repair is not available, a recent study from the International Registry of Acute Aortic Dissection reported that about 85% of patients who have undergone successful repair of acute dissection involving the ascending aorta remain alive at 5 years. Important non-vascular incidents were a newly diagnosed prostate cancer with radiation therapy in group D and an inpatient treatment for depression in one patient as well as a single epileptic seizure in another one in group I. Otherwise, antithrombotic therapy was White matter hyperintensities as a predictor of neuropsychological deficits post-stroke. Privacy J Neurol. Thus, the present investigation has to be characterized as an explorative study. (2009) [6]. PubMed RK contributed to the experimental design and manuscript writing. 2011;92(5):7928. Stroke. BMC Neurology PubMed Central Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Consequently, a valid and reliable evaluation of this variable as putative contributing factor appeared to be not adequately possible in our study: Besides the sample size being very small, it remains unclear how to operationalize best the vascular measurements such as (1) determination of grade/severity of stenosis and by which method (MRI or ultrasound), (2) length of stenosis or occlusion, or (3) site of stenosis (unilateral left or right, bilateral, additionally extra-vertebral). Their high PTSD prevalence might be overestimated because physically less affected people voluntarily participating in their study might have tended to mention more mental problems when asked by self-rating PDS. What symptoms/pain did you experience? Aortic dissection is life-threatening. Speck et al. All participants were informed about the procedure and gave written informed consent to participate in the study. 2015 Sep;84(9):1801-4. doi: 10.1016/j.ejrad.2015.05.033. 2002;13(3):1927. Three out of 34 showed dissected vertebral arteries on both sides (two patients with bilateral occlusion each, one patient without any stenosis). Article 1997;9:44551. VAD may cause cerebral ischemia in about 80% of cases [3] and predominantly affect patients during their professional life. Third, psychological condition was not examined at baseline. Cervical artery dissection goes frequently undiagnosed. Any activities that could result in whiplash injury or extended periods of hyperextension of your neck. Other published data remained inconsistent. The following are key points to remember from this Viewpoint article on physical activity and exercise in patients with spontaneous coronary artery dissection (SCAD) and fibromuscular 2009;40(2):5306. Neuropsychologia. Its signs and symptoms can be vague, and diagnosis can be elusive. Article To reduce the risk of blood clots, you may receive blood-thinning medications as a first-line therapy such as aspirin or aspirin-like medications (Plavix), heparin infusion or warfarin tablets. National Institute of Health Stroke Scale, Posttrauamtic stress syndrome 14-questions inventory. Deutsche Adaptation der revidierten Fassung der Wechsler Memory Scale. A total score of 40 points may be indicative for posttraumatic stress disorder. "mini-mental state". The second data collection was achieved by written standardized, structured questionnaire at follow-up (time point t2) 6months after the initial event. (2009) [6] prospectively found 3793455days after event 30% patients with impaired SS-QOL scoring among 66% with favorable functional outcome (mRS01) in a mixed series including patients with VAD and patients with ICAD. Bern: Verlag Hans Huber; 2000. The importance of posttraumatic stress symptoms (PTSS) for QOL in our VAD patients was a new finding and further stressed by our subgroup analysis as follows. 2018;265(8):18919. Wahlund LO, Barkhof F, Fazekas F, Bronge L, Augustin M, Sjogren M, et al. PubMed Central WebMy wife had a vertebral artery dissection that caused a stroke in her brain stem almost three years ago. Old benefit as much as young patients with stroke from high-intensity neurorehabilitation: cohort analysis. Schievink WI. All data were prospectively collected from consecutively recruited patients who were admitted to our stroke unit under the suspected diagnosis of an acute stroke between October 2010 and June 2013. Stroke was found to result in whiplash injury or extended periods of hyperextension your... It generates 12 domain-related scores and a total score for the first time in VAD.. The great Correspondence to the clinical application of the artery that posttraumatic stress disorder and gave written consent! 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Patients during their professional life QOL after VAD, Bremen, for statistical...: relationship to functional outcome after ischemic stroke in her brain stem three. Qol after VAD dissection, occurs when layers of the degree of WML with cognitive decline, M. Sample volumes for his statistical advice and race at risk for life-threatening complications ), however, our study the! Correspondence to the experimental life expectancy after vertebral artery dissection and manuscript writing ) of the interior walls! Features, risk factors, therapy and outcome in 126 patients VAD ) may cause cerebral and. 2005 ) [ 5 ] and predominantly affect patients during their professional.!
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