CAS We thank Dr. Werner Wosniok from the Institute of Statistics at the University of Bremen, Bremen, for his statistical advice. Neurology. Engelter ST, Grond-Ginsbach C, Metso TM, Metso AJ, Kloss M, Debette S, et al. (2009) [40] reported that severe periventricular white matter disease was significantly associated with poor functional outcome at 3months after ischemic stroke, independently of other factors. Jokinen H, Kalska H, Mantyla R, Ylikoski R, Hietanen M, Pohjasvaara T, et al. It can be induced by a particular head or neck posture; its early signs often include headache and neck pain. 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. Koolhaas JM, Bartolomucci A, Buwalda B, de Boer SF, Flugge G, Korte SM, et al. (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. 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. Likewise, there was no statistical group difference of the mean values of the total quality of life score measured by SS-QOL. Grabowska-Fudala B, Jaracz K, Gorna K, Miechowicz I, Wojtasz I, Jaracz J, et al. Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): a randomised trial. 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). Stroke. J Clin Neurol. This option is also for people with hemorrhagic stroke. Springer Nature. 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. Neuropsychologia. The other variables showed no significant differences. J Neurol. What symptoms/pain did you experience? Radiographics. The higher the score the more probable is a posttraumatic disorder. Traenka et al. Sometimes, your healthcare provider may recommend conventional angiography. 2008;28(6):171128. 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). Group D only displayed a significant lower mean value than groups I and M in the domain social roles. You may face a higher risk of dissection if you have certain health conditions, including: Injury can also cause dissection. Data about pathological results of neuropsychological test battery assessment. All participants were informed about the procedure and gave written informed consent to participate in the study. The aim of this study was the multimodal analysis of patient characteristics after VAD to identify contributing factors. On rare occasions, this can lead to stroke. Exner C, Weniger G, Irle E. Cerebellar lesions in the PICA but not SCA territory impair cognition. 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. Neurological outcome and quality of life after stroke due to vertebral artery dissection. Rainer J. Strege. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Follow-up group comparison of variables of paired samples for changes over time was performed by using the Wilcoxon-test. Measurements of acute cerebral infarction: a clinical examination scale. Twenty-three patients with VAD had (subtotal) occlusion, eight patients a stenosis and three no significant stenosis. N Engl J Med. Vulnerability--a new view of schizophrenia. Toglia J, Fitzgerald KA, O'Dell MW, Mastrogiovanni AR, Lin CD. Moreover, our data demonstrated no role of WML as independent predictor of QOL. Arch Phys Med Rehabil. Thirty-one of 62 study participants completed 18.922.72months after discharge four tests of attention and memory function. In addition, differentiation of dissection from rupture of atheroma in the context of arteriosclerosis may be difficult so that Ahl et al. Your two carotid arteries run along either side of your neck in the front. WebIf 3-month ultrasound follow up or MRA showed complete recanalization of the vertebral artery, antithrombotic therapy was stopped. Classification of subtype of acute ischemic stroke. The data suggest that posttraumatic stress symptoms are of significant importance for the QOL after VAD. Background: Vertebral artery dissection (VAD) may cause cerebral ischemia and impair quality of life (QOL) despite of good functional outcome. The elevated levels of stress symptoms after VAD in our study may be interpreted as maladaptive psychological state/condition. 1989;20(7):86470. It may also occur with sudden neck movements and trauma. Fourth, maladaptive coping strategies were significant predictors for and associated with posttraumatic stress disorder in patients with cervical artery dissection in the study of Speck et al. Another 66years old patient with medulla oblongata infarction deceased due to nonspecific heart failure and was lost for follow-up; in group I one stroke and two myocardial infarcts occured; group M remained without any vascular event. Secondary exclusion due to defined criteria decreased the number of baseline patients of group D to 34 and group M to 25. (2005) [41], for example, noted a correlation of the degree of WML with cognitive decline. J Neurol Neurosurg Psychiatry. It can also lead to swelling (dilation) of the artery. https://doi.org/10.1186/s12883-019-1541-x, DOI: https://doi.org/10.1186/s12883-019-1541-x. Psychophysiological response to virtual reality and subthreshold posttraumatic stress disorder symptoms in recently deployed military. Blood in the separated layers of the vessel wall can lead to blood clot formation. WebFibromuscular dysplasia (FMD) affects the artery walls, making them either too weak or too stiff. A summary score of 4.0 was considered to indicate good QOL, a score3.9 bad QOL in accordance with Fisher et al. Patient-specific recovery patterns over time measured by dependence in activities of daily living after stroke and post-stroke care: the South London Stroke Register (SLSR). The main findings were found in subgroup D (mRS 02) with bad QOL3.9 that were significantly higher mean values for premorbid anxiety symptoms (p=0.006) and stress symptoms at follow-up (p=0.002). Definitions for use in a multicenter clinical trial. Impact of anxiety on health-related quality of life after stroke: a cross-sectional study. Patients most commonly present with neck pain, headache, visual disturbance, or focal extremity weakness. Psychometric self-rating tools, as used in this study, may enable timely detection of such sequelae and facilitate therapeutic intervention. (2004) [58] proposed the term of atherosclerotic dissection for certain cases. 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. (2014) [46], mean age 44.8years. PubMed Chronic posttraumatic stress symptoms after nonsevere stroke. Get useful, helpful and relevant health + wellness information. Auflage. Tucson: Neuropsychological Press; 1985. The Neurological Institute is a leader in treating and researching the most complex neurological disorders and advancing innovations in neurology. Zubin J, Spring B. Aschenbrenner S, Tucha O, Lange KW. It leads to a reduced QOL in a significant percentage of patients despite good functional outcome. Article 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. A dissection forms when theres a tear in one or more of its three tissue layers. The second data collection was achieved by written standardized, structured questionnaire at follow-up (time point t2) 6months after the initial event. 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. 2011;134(Pt 12):367286. From October 1, 2010, to June 31, 2013, 42 consecutive patients with spontaneous first-time vertebral artery dissection (VAD), who were admitted to our hospital under the suspected diagnosis of an acute stroke, were registered and screened for this study. Tedesco AM, Chiricozzi FR, Clausi S, Lupo M, Molinari M, Leggio MG. Your chances of experiencing a stroke are low. Comparison of cognitive baseline profiles of the three groups revealed no significant differences. 2005;1(1):5968. (2014) [46]. 1977;86(2):10326. 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 In recent years, however, patient-centered outcome measures such as quality of life (QOL) gained increasing importance. Traenka C, Jung S, Gralla J, Kurmann R, Stippich C, Simonetti BG, et al. Differences in baseline or follow-up characteristics between the three groups (D, I, M) were analyzed with Chi-square tests for categorical and with Kruskal-Wallis-test (H-test) for metric variables. Kiphuth IC, Utz KS, Noble AJ, Kohrmann M, Schenk T. Increased prevalence of posttraumatic stress disorder in patients after transient ischemic attack. WebCervical artery dissections typically heal very well, returning the vessel to normal. As a key result, higher levels of posttraumatic stress symptoms appeared to be a prominent contributing factor to bad QOL in VAD patients with otherwise good functional outcome. Chicago: University of Chicago Press; 1947. Because only three of them showed any signs of cognitive impairment, the authors argued that deficits were unlikely responsible for the reduced QOL. Foa E, Cashman L, Jaycox L, Perry K. The validation of a self-report measure of posttraumatic stress disorder: the posttraumatic diagnostic scale. 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. Google Scholar. 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. 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. Spontaneous dissection of the carotid and vertebral arteries. VAD affected the right side in 13 patients (38.2%), the left side in 18 patients (53%), and both sides in three patients (8.8%). Halstead WC. 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 cumulative survival rate among all types of stroke in this study was found to be 48% at five years. Spearmans rank correlation analysis yielded a highly significant correlation (p<0.001) between all three cognitive scoring systems (MMSE, MoCA, and CCS). 2. MoCA, to our best knowledge, was used in our study for the first time in VAD patients. 2014;45(11):33606. California Privacy Statement, Other important findings were found in subgroup I (mRS02) with bad QOL that were significantly higher mean values for premorbid anxiety symptoms (p=0.002) and depression symptoms (p<0.001). Thomas LC, Rivett DA, Attia JR, Levi CR. The multivariate analysis of 126 patients with carotid and vertebral artery dissections in a retrospective study design showed that the variables stroke and arterial occlusion were independent factors associated with a poor outcome [37]. This method enables healthcare providers to quickly pinpoint the dissection and determine its severity and acuity. In the SSQOL-subgroup analysis of patients with good functional outcome (mRS score2) and good SS-QOL score (4.0) at follow-up were eight patients with arterial occlusion or subtotal occlusion versus five with or without stenosis. Web2. 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. (3) The upper inclusion limit of age range for our study was quite high with 85years. About 40% of patients die immediately from complete rupture and bleeding out from the aorta. 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]. PubMed Central Privacy Herzogenrath: Vera Fimm; 2009. All participants have given written informed consent. The mini-mental state examination and Montreal cognitive assessment in persons with mild subacute stroke: relationship to functional outcome. CTA, MRI, and RJS contributed to the experimental design, neuropsychological testing, data acquisition, data analyses and manuscript writing. 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. Summary A 22-year-old male with no previous history of cardiovascular disease presented after a high-speed rollover motor vehicle collision. Anasthesiol Intensivmed Notfallmed Schmerzther. Procedures for vertebral artery dissection include: Most people make a full recovery. 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. With a dissection, blood gets trapped between the intima and media. [43] who preoperatively examined patients with cerebellar hematomas or brain tumors by the same neuropsychological tests apart from not using LPS as we did. In this context the following aspects seem to be worthy to note: First, elevated scores of stress symptoms were also found in patients without any stroke lesion in our study in line with other study results [50]. Turm von London Deutsche Version. Manage cookies/Do not sell my data we use in the preference centre. All groups (D, I, and M) displayed a significant correlation between age and white matter lesions (WML). Provided by the Springer Nature SharedIt content-sharing initiative. Three out of 34 showed dissected vertebral arteries on both sides (two patients with bilateral occlusion each, one patient without any stenosis). 2014;23(2):33542. Among physical domains only the domain work showed also deterioration in groups D and I. Brain and intelligence: a quantitative study of the frontal lobes. Speck et al. Therefore, mRS scoring of 02 at follow-up was used as a good functional outcome. Kwa VI, Limburg M, de Haan RJ. Over the last years, cervical artery dissection has been increasingly diagnosed due to improved neuroimaging methods [58]. Cross sectional analysis of our baseline data displayed no significant group differences regarding sociodemographic variables. Even if WML predominated in groups D and I compared to stroke mimics, they showed no significant inter-group difference. (2002) [5], mean age 50years, (2) posttraumatic stress symptoms as significant predictor for reduced SS-QOL Speck et al. 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. Arch Phys Med Rehabil. Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, et al. Your vertebral artery runs along the back of your neck and supplies your brain and spine with oxygen-rich blood. Psychol Assess. Is a leader in treating and researching the most complex neurological disorders and advancing innovations neurology. Stroke in this study, may enable timely detection of such sequelae and facilitate therapeutic intervention a head. 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Your vertebral artery dissection include: most people make a full recovery Tucha,! To defined criteria decreased the number of baseline patients of group D only displayed a significant correlation age..., Debette S, et al either too weak or too stiff patients. Neuroimaging methods [ 58 ] proposed the term of atherosclerotic dissection for cases!