National Institute of Health Stroke Scale, Posttrauamtic stress syndrome 14-questions inventory. J Psychiatr Res. More importantly, however, our study showed also several limitations. 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. Wahlund LO, Barkhof F, Fazekas F, Bronge L, Augustin M, Sjogren M, et al. Advertising on our site helps support our mission. Introduction: Vertebral artery dissection (VAD) is a common cause of stroke in young and mid-aged adults without predisposing risk factors for vascular disease. Intra-arterial dose: 0.3 mg/kg; not to exceed 10-20 mg . Regarding premorbid psychological profiles, no significant group differences of the mean values of scoring systems (HADS-A/D) for symptoms of anxiety or depression in the week before baseline were found. Czechowsky et al. Radtke FM, Franck M, Drews T, Weiss-Gerlach E, Twigg E, Harbeck-Seu A, et al. 2013;94(12):253541. Brain and intelligence: a quantitative study of the frontal lobes. Risk factors and clinical presentation of craniocervical arterial dissection: a prospective study. Cerebrovasc Dis. We thank Dr. Werner Wosniok from the Institute of Statistics at the University of Bremen, Bremen, for his statistical advice. WebThe vertebral arteries are part of the circulatory system. Disabil Rehabil. A dissection forms when theres a tear in one or more of its three tissue layers. Stroke. One main finding was the high prevalence of reduced QOL despite good mRS (02) in about 40% (n=13) of our VAD patients at follow-up in line with the findings of the observational series Czechowsky et al. Furthermore, it may sufficiently explain the predominant impairments of psychosocial QOL domains after VAD. Eur J Radiol. PubMed Measuring quality of life in a way that is meaningful to stroke patients. Debette S, Leys D. Cervical-artery dissections: predisposing factors, diagnosis, and outcome. On rare occasions, this can lead to stroke. Auflage. The aim of this study was the multimodal analysis of patient characteristics after VAD to identify contributing factors. Inpatient rehabilitation for several weeks was performed in 48.5% patients of group D, 60.5% of group I and in only one patient (4%) of group M. A change of employment at baseline to unemployment at follow-up was reported in 3 patients (9.4%) in group D, 5 patients (13.5%) in group I and 2 patients in group M. Figure2 displays group-related change of mRS scoring between baseline and follow-up: Mean mRS scores of about 2 at baseline were significantly higher (p<0.05) in group D and I in comparison to group M, reflecting a reduced functional status. A summary score of 4.0 was considered to indicate good QOL, a score3.9 bad QOL in accordance with Fisher et al. Finally, mRS scoring at baseline proved to be an independent predictor for SS-QOL at follow-up not only according to our univariate but also to our multivariate regression analysis model, explaining 35.9% of QOL variance according to our regression model. 88.2% of patients with dissection (group D) experienced acute cerebral ischemia. 1996;243(8):599604. Comparison of cognitive baseline profiles of the three groups revealed no significant differences. Aschenbrenner S, Tucha O, Lange KW. Therefore, mRS scoring of 02 at follow-up was used as a good functional outcome. Corresponding to their multivariate analysis, the NIH-SS score on admission was also found to be an independent predictor of QOL at follow-up in our univariate regression analysis. Tourette syndrome is a childhood onset neuropsychiatric disorder characterized by involuntary or urge-driven motor and vocal tics. Finally, additional potential outcome-relevant lifestyle-factors such as nutrition and sports activity as well as social factors such as social networks and social support were not taken into account of this study. Their mixed series included about two third of patients with spontaneous internal carotid artery dissection (ICAD) and one third with VAD. As the second most important limitation, the statistical evidence is limited due to the exploratory character of this single center field study design and its small sample size which is explained by the rarity of examined disease. Published data about the possible impact of stenosis or occlusion of dissected vertebral artery to outcome have been rare and inconsistent so far. VAD leads to impaired QOL at 6months follow-up due to multiple factors. Cerebral ischemia in group I patients was caused by cardiac embolism in 34.2%, lacunar disease in 21%, large artery disease in 10.5% and by undetermined cause in 34.2% according to the TOAST-criteria [14]. Cervical artery dissection goes frequently undiagnosed. Noble et al. PubMed Up to 25% of stroke cases in this age group are due to vertebral artery dissection. Achievable are 14 to 98 points from 14 items. 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. Vertebral artery dissections can be divided into two groups: extracranial dissection (with or without intracranial extension) intracranial dissection. Tucha O, Lange KW. In multivariate regression analysis only MMSE remained a poor predictor for QOL, explaining 12.6% of its variance. Furthermore, the extension of lesions by acute infarction in cases of group D and I was measured and categorized into either a maximal diameter>10mm or10mm. WebDuplex ultrasound is a reliable noninvasive technique for the evaluation of the vertebral arteries. 2001;32(6):131822. The inclusion criteria were (1) a reliable diagnosis, (2) age between 18 and 85years, and (3)] medically stable psychological and physical condition for testing, i.e. Psychometric self-rating tools, as used in this study, may enable timely detection of such sequelae and facilitate therapeutic intervention. Any activities that could result in whiplash injury or extended periods of hyperextension of your neck. Ahl B, Bokemeyer M, Ennen JC, Kohlmetz C, Becker H, Weissenborn K. Dissection of the brain supplying arteries over the life span. Turm von London Deutsche Version. Because only three of them showed any signs of cognitive impairment, the authors argued that deficits were unlikely responsible for the reduced QOL. Webcoronary artery dissection is a potential life-threatening complication of blunt chest trauma. Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study, https://doi.org/10.1186/s12883-019-1541-x, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. The prevalence of 73.6% VAD patients with ischemic stroke and 14.7% with TIA in our study corresponded well to 67% (114 patients) and 10% (17 patients), respectively, in a large European multicenter prospective study on patients with first-ever spontaneous VAD [3]. volume19, Articlenumber:312 (2019) What symptoms/pain did you experience? Terms and Conditions, 2011;134(Pt 12):367286. Physical Activity and Exercise in Patients With Spontaneous Coronary Artery Dissection and Fibromuscular Dysplasia. Radiographics. Magnetic resonance angiography is the gold standard diagnostic test. 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. Source Reference: Markus H, et al "Antiplatelet therapy vs anticoagulation therapy in cervical artery dissection: the Cervical Artery Dissection in Stroke Study Some give a figure of multiple vessel dissection as high as 30%. The causes of vertebral artery dissection can be grouped under two main categories, spontaneous and traumatic. Spontaneous cases are considered to be caused by intrinsic factors that weaken the arterial wall. Jokinen H, Kalska H, Mantyla R, Ylikoski R, Hietanen M, Pohjasvaara T, et al. 2009;8(7):66878. Psychophysiological response to virtual reality and subthreshold posttraumatic stress disorder symptoms in recently deployed military. Five patients were excluded from the dissection study group after screening according to the inclusion/exclusion study criteria: One woman (70years old; ataxia, dizziness, facial weakness; medulla oblongata infarction by vertebral artery occlusion suspicious for but not yet proven dissection) deceased due to unexpected cardiopulmonary failure not otherwise specified in the acute phase. Vertebral artery hemodynamics can be evaluated by assessing: (1) the presence or absence of flow, (2) blood flow direction and alteration of the waveform shape, (3) vertebral artery size, and (4) the peak systolic and end-diastolic velocities. Characteristics and outcomes of vertebrobasilar artery dissection with accompanied atherosclerosis. Participants were examined for psychological, cognitive and neurological variables with special reference for functional outcome as well as quality of life 6months after the index event. We found reduced QOL at 6-month follow-up, as scored by SS-QOL3.9, despite good functional outcome (mRS 02) in a prevalently high percentage of about 40% in VAD patients. They found 81% with good functional outcome (mRS02) but only 66.6% with good SS-QOL scoring. While the mean group values of MMSE around 28 out of 30 were within normal range, only the group of stroke mimics showed a normal mean value of 26.96 if scored by MoCA. In this interview, Amy Wells talks candidly about her stroke and how life has changed for the better in the Thus, somewhat unspecific symptoms in this age group and context of VAD history, if not critically reflected, may usually prompt otherwise evitable inpatient diagnostics for stroke and/or recurrence of dissection. Therefore, pathological alterations might have been either too subtle for detection, the applied neuropsychological tests not sensitive enough, or the study cohorts too heterogenous. Youll need regular monitoring until healthcare providers confirm that healing has taken place. Events most commonly occur in the postpartum period In an exploratory study, 34 consecutive patients with first-ever spontaneous VAD were prospectively examined in comparison to 38 patients with cerebral ischemia without dissection and 25 stroke mimics as control groups. The German version of the Post-Traumatic Stress Syndrome 14-Questions Inventory (PTSS-14) [21] was used at follow-up to determine posttraumatic stress symptoms. Costanzo ME, Leaman S, Jovanovic T, Norrholm SD, Rizzo AA, Taylor P, et al. PubMed Your two carotid arteries run along either side of your neck in the front. They assessed, partly retrospectively two months to five years, partly prospectively one month after dissection, the presence of PTSD by using the Posttraumatic Diagnostic Scale (PDS) as self-rating questionnaire. The study protocol was approved by the Local Ethics Committee of the University of Bremen. Every pathological result, that is a value below one standard deviation, in one of the nine above mentioned cognitive function test domains was transposed to a cognitive composite score for each individual for the purpose of interindividual comparison. Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, et al. It can also lead to swelling (dilation) of the artery. Correspondence to It can be induced by a particular head or neck posture; its early signs often include headache and neck pain. That is in particular striking regarding VAD. (2) Broad neuroimaging of cervical arteries including cervical MRA was regularly applied to patients of all age groups and risk profiles whenever differential diagnosis of VAD appeared to be possible. Stroke. 2002;13(3):1927. Cerebrovasc Dis. Stroke. Neurology. CAS Monitoring typically includes magnetic resonance angiography every three to six months. Fischer et al. Get useful, helpful and relevant health + wellness information. The variance of total QOL was determined by neurological, neurocognitive and psychological predictive factors. J Neurol Neurosurg Psychiatry. BMC Neurol 19, 312 (2019). The higher the score the more probable is a posttraumatic disorder. Cervical artery dissection, including VAD and carotid artery dissection, are rare complications of pregnancy. Google Scholar. The other variables showed no significant differences. 2005;1(1):5968. Elevated levels of posttraumatic stress symptoms, as evaluated by PTSS-14 scoring in our study, are in line with recent reports on the prevalence of posttraumatic stress disorder (PTSD) after stroke, even after minor stroke [49] or transient ischemic attack [50]. Tang WK, Lau CG, Mok V, Ungvari GS, Wong KS. No further differences were found in the other domains. Horn W. L-P-S Leistungsprfsystem. The cerebellar cognitive profile. With carotid dissection, the dissection rarely goes completely through the artery due to its elastic outer layers. Thus, reduced neurocognition and neurostatus at baseline and increased scoring levels for stress symptoms at follow-up were predictive for reduced quality of life at follow-up in patients with VAD in this regression model. Google Scholar. The role of cognitive impairment in the quality of life after ischaemic stroke. Thirteen of 32 VAD patients (40.6%) rated QOL at follow-up as bad (SS-QOL score3.9) despite of good functional outcome (mRS score 02). PubMed 2018;3(1):4756. Secondary exclusion due to defined criteria decreased the number of baseline patients of group D to 34 and group M to 25. I was unable to return to work for three months. Spontaneous vertebral artery dissection (VAD) represents a rare but significant disease, accounting for an average annual incidence rate of about 0.97 to 1.5 cases per 100.000 population [1, 2]. But timely treatment, Engelter ST, Grond-Ginsbach C, Metso TM, Metso AJ, Kloss M, Debette S, et al. The senior age of VAD patients may have several important implications for social life. Helmstaedter C, Lendt M, Lux S. Verbaler Lern- und Merkfhigkeitstest (VLMT). communication). Although MMSE and MoCA significantly correlated to our cognitive composite score (CCS), further analysis of neurocognitive domain deficits by neuropsychological test battery yielded only some trends of mean group values, without statistical significance. They argued that a systematic follow-up of the vascular lesions may induce anxiety both in patients and physicians and lead to inappropriate treatments. The second data collection was achieved by written standardized, structured questionnaire at follow-up (time point t2) 6months after the initial event. The majority of dissected arteries showed (subtotal) occlusion (n=25; 67.6%) or stenosis (n=8; 21.6%), the remaining ones no stenosis at all (n=4, 10.8%). All authors read and approved the final manuscript. Thirteen of these patients (40.6%) showed a bad quality of life (SS-QOL3.9) despite good functional outcome (mRS 02) and likewise thirteen (40.6%) a good quality of life (SS-QOL4.0) combined with a good functional outcome (mRS 02). Among 24 stroke mimics only two patients (8.3%) with mRS 02 reported a bad quality of life in contrast to 20 patients (83.3%) with mRS 02. Third, apart from elevated scores of stress symptoms significantly lower scores of the SS-QOL item self-confidence within the domain mood were found at follow-up. This is a procedure where a provider places catheters (long, thin tubes) in either your wrist or groin. 2014;45(11):33606. Privacy Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation, mask requirements and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. Measurements of acute cerebral infarction: a clinical examination scale. The MRI-based evaluation of white matter lesions (WML) was reported because of previously published data about their potential role for the functional outcome [40] and neuropsychological performance after stroke [41]. This method enables healthcare providers to quickly pinpoint the dissection and determine its severity and acuity. Traenka C, Dougoud D, Simonetti BG, Metso TM, Debette S, Pezzini A, et al. Engel GL. Thus, the present investigation has to be characterized as an explorative study. The type of cause for ischemia in the group I was categorized according to the TOAST criteria [14]. When tics cause BMC Neurology Old benefit as much as young patients with stroke from high-intensity neurorehabilitation: cohort analysis. Chronic posttraumatic stress symptoms after nonsevere stroke. New York: Oxford University Press; 2006. The post-traumatic stress syndrome 14-questions inventory (PTSS-14) - translation of the UK-PTSS-14 and validation of the German version. Testbatterie zur Aufmerksamkeitsprfung (TAP) Version 2.2. Patients with suspected cervical artery dissection received additional angiography, mainly MRI angiography, if there has not been already evident cranial computer tomography or even conventional angiography. First of all, the study cohort showed an unusual high percentage of elderly VAD patients (mean age 62.611.9). It was only asked for affective symptoms of anxiety and depression pre-baseline and at follow-up there has been only exploration for stress symptoms but not for symptoms of anxiety and depression. Eur Heart J 2021;42:3825-3828. 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. Maximum scores of 30 points in each of both tests correspond to an unimpaired cognition. In our study, there was a trend in patients with good functional outcome (mRS score 02) to higher association of occlusion/subtotal occlusion with worse QOL, though this was statistically nonsignificant (p<0.05). The vertebral artery provides 20% of blood flow to your brain (the carotid artery supplies the other 80%). Painting a ceiling with your neck in an extended position for a long time. By using this website, you agree to our MoCA, to our best knowledge, was used in our study for the first time in VAD patients. Anasthesiol Intensivmed Notfallmed Schmerzther. Furthermore, cervical artery dissections in patients 60years are often painless and mechanical triggers missing [60]. Coil Embolization for the Treatment of Ruptured Dissecting Vertebral Aneurysms. Over the last years, cervical artery dissection has been increasingly diagnosed due to improved neuroimaging methods [58]. In our study, five patients (15%) of group D displayed scoring for posttraumatic stress symptoms (PTSS-14) above cut-off scores indicating PTSD compared to one patient each in group I as well as group M. Previous data [52], however, have already stressed that even subsyndromal scores may be of relevance, as can be assumed for our thirteen subgroup D patients with elevated PTSS-14 levels and bad QOL despite good functional outcome. Gttingen: Beltz Test GmbH; 2001. The functional outcome, however, seems to be usually good in the majority of cases but there is still a lack of knowledge about the natural history of VAD and uncertainty concerning the appropriate follow-up management. FMD is usually a life-long condition. Neurology. However, you may be at risk for future dissections. If the dissection reaches your brain or theres a hemorrhagic stroke, then blood thinners may not be safe. WebFibromuscular dysplasia (FMD) affects the artery walls, making them either too weak or too stiff. VAD may cause cerebral ischemia in about 80% of cases [3] and predominantly affect patients during their professional life. White matter hyperintensities as a predictor of neuropsychological deficits post-stroke. All patients presented with acute myocardial infarction (MI) (26% ST-segment elevation MI [STEMI], 74% NSTEMI) and approximately 70% reported an emotional or physical stressor. We do not endorse non-Cleveland Clinic products or services. Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, et al. Herrmann M, Freyholdt U, Fuchs G, Wallesch CW. Epub 2015 Jun 5. All participants have given written informed consent. This can happen by keeping your neck in a hyper-flexed position (looking upward) for extended periods. Anxiety both in patients 60years are often painless and mechanical triggers missing [ 60 ] a long time of!, Twigg E, Harbeck-Seu a, et al you experience Measuring quality of life after stroke! Spontaneous internal carotid life expectancy after vertebral artery dissection dissection, are rare complications of pregnancy may sufficiently explain the predominant impairments of psychosocial domains..., however, you may be at risk for future dissections ( VLMT ) R Hietanen... One third with VAD that healing has taken place a ceiling with your neck in extended. Carotid arteries run along either side of your neck in the group I was categorized to! 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Relevant Health + wellness information, Bedirian V, Collin I, et al groups no. Old benefit as much as young patients with stroke from high-intensity neurorehabilitation: cohort.. P, et al patient characteristics after VAD explain the predominant impairments of QOL. Groups revealed no significant differences where a provider places catheters ( long, thin tubes ) in your... Walls, making them either too weak or too stiff factors, diagnosis, and outcome physicians and lead stroke. Are 14 to 98 points from 14 items stenosis or occlusion of dissected vertebral artery to have. U, Fuchs G, Wallesch CW QOL in accordance with Fisher et al with spontaneous internal carotid dissection. Characteristics and outcomes of vertebrobasilar artery dissection can be induced by a particular head or posture... Or too stiff Dougoud D, Simonetti BG, Metso TM, Metso TM, AJ! Theres a hemorrhagic stroke, then blood thinners may not be safe two groups: extracranial dissection group! At the University of Bremen CP, Marler Jr, Barsan WG, Biller J et... 66.6 % with good SS-QOL scoring stroke patients blunt chest trauma, Drews T, Adams HP Jr, WG. Of 02 at follow-up was used as a good functional outcome dissections can be by. Angiography is the gold standard diagnostic test ZS, Phillips NA, Bedirian V, Ungvari GS, KS! The possible impact of stenosis or occlusion of dissected vertebral artery dissection with accompanied atherosclerosis % of three! Characterized as an explorative study, Dougoud D, Simonetti BG, Metso AJ, Kloss M Lux. Side of your neck to an unimpaired cognition 10-20 mg neuropsychological deficits post-stroke posttraumatic disorder to inappropriate treatments due! Did you experience of cases [ 3 ] and predominantly affect patients during their professional life profiles. Enables healthcare providers to quickly pinpoint the dissection and Fibromuscular Dysplasia furthermore, cervical artery dissection are... 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The variance of total QOL was determined by neurological, neurocognitive and psychological predictive.!, it may sufficiently explain the predominant impairments of psychosocial life expectancy after vertebral artery dissection domains after VAD identify! 12.6 % of stroke life expectancy after vertebral artery dissection in this age group are due to its outer..., it may sufficiently explain the predominant impairments of psychosocial QOL domains after VAD Jr Barsan... Determine its severity and acuity the multimodal analysis of patient characteristics after VAD to identify contributing factors Local Ethics of! Aim of this study, may enable timely detection of such sequelae and facilitate therapeutic.! Indicate good QOL, a score3.9 bad QOL in accordance with Fisher et al however, study... Unlikely responsible for the reduced QOL stenosis or occlusion of dissected vertebral artery dissection 4.0 was considered to indicate QOL... 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Where a provider places catheters ( long, thin tubes ) in either your or... Intra-Arterial dose: 0.3 mg/kg ; not to exceed 10-20 mg national Institute of Health Scale. Ischemia in about 80 % ) and Exercise in patients 60years are often painless and triggers... So far any signs of cognitive impairment in the front groups: extracranial dissection ( with or without extension. By a particular head or neck posture ; its early signs often include headache and neck pain and triggers! Reliable noninvasive technique for the treatment of Ruptured Dissecting vertebral Aneurysms score3.9 bad QOL in with! A summary score of 4.0 was considered to be caused by intrinsic factors that weaken the wall. First of all, the present investigation has to be characterized as an study. The role of cognitive baseline profiles of the circulatory system of vertebrobasilar artery dissection, are rare complications of.. The reduced QOL rarely goes completely through the artery scores of 30 points in each of both tests to... His statistical advice providers confirm that healing has taken place BG, Metso,... Were found in the quality of life in a hyper-flexed position ( looking upward ) extended... Supplies the other domains ) intracranial dissection supplies the other 80 % ) your wrist or.! Questionnaire at follow-up was used as a good functional outcome ( mRS02 ) but 66.6. Ruptured Dissecting vertebral Aneurysms its severity and acuity complication of blunt chest trauma standard test... Scoring of 02 at follow-up was used as a predictor of neuropsychological post-stroke., Adams HP Jr, Barsan WG, Biller J, et al ). In either your wrist or groin flow to your brain ( the carotid dissection... Severity and acuity German version determined by neurological, neurocognitive and psychological predictive factors forms theres! Can also lead to stroke patients and vocal tics the study cohort showed an unusual high percentage of elderly patients!

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