It provides seven scoring levels as follows: (0) no symptoms at all, (1) no significant disability despite symptoms, (2) slight disability, (3) moderate disability, (4) moderately severe disability, (5) severe disability, and (6) dead. 88.2% of patients with dissection (group D) experienced acute cerebral ischemia. It can affect blood flow, putting you at risk for life-threatening complications. It may also occur with sudden neck movements and trauma. Intergroup analysis of change of mean total scores of QOL, as measured by SS-QOL, from pre-baseline to follow-up displayed a significant deterioration (p<0.001; Wilcoxon signed-rank test) in groups D and I but not in group M. Further analysis of changing scores in the twelve SS-QOL domains yielded developing impairments from baseline to follow-up in all three groups D, I, and M. Impairments evolved mainly in psychosocial domains such as family roles, social roles and energy and less in physical domains. Chronic posttraumatic stress symptoms after nonsevere stroke. Last reviewed by a Cleveland Clinic medical professional on 08/07/2022. It contains 49 items belonging to 12 domains. Blood in the separated layers of the vessel wall can lead to blood clot formation. 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. This exploratory study was carried out in the Neurological Department of the University-affiliated teaching hospital AGAPLESION Diakonieklinikum Rotenburg, Germany. The use of the German version in this study was authorized by their authors (pers. 1997;9:44551. While there were in groups D and I compared to group M frequent impairments in both global screening tests (MMSE, MoCA) and in single cognitive function tests of the neuropsychological test battery (Additionalfile1) and also in the resulting cognitive composite score (CCS), this difference reached statistical significance only in the MoCA assessment for group D compared to group M (Table2). Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): a randomised trial. Among physical domains only the domain work showed also deterioration in groups D and I. 2016;87(5):52630. 2011;35(5):1291301. Depressive symptoms in stroke patients treated and non-treated with intravenous thrombolytic therapy: a 1-year follow-up study. These findings corresponded widely to findings of Gottwald et al. 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. 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. Anasthesiol Intensivmed Notfallmed Schmerzther. (2015) [61] reported that older stroke patients in general have worse prestroke status, greater impairment on hospital admission, more comorbidities and poorer poststroke functional status than the younger patients but can benefit as much as the young from high-intensity neurorehabilitation. Tucha O, Lange KW. 2001;32(6):131822. (2009) [6]. The overrepresentation of elderly patients in our study may be most probably explained to some extent by a hospital-based selection bias: (1) Patients were recruited when referred to the supraregional stroke unit of our teaching hospital. 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. Psychological self assessment for symptoms of depression (HADS-D/D), symptoms of anxiety (HADS-D/A), and posttraumatic stress symptoms (PTSS-14) showed significantly positive correlations in all groups. "mini-mental state". Neurology. Data about pathological results of neuropsychological test battery assessment. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. For both future research and clinical treatment, our data favor a multidimensional monitoring after VAD, with special focus on neuropsychiatric sequelae. In case of significant difference, a subsequent analysis between two group pairs was performed: For categorical variables the Chi-square test or Fishers exact test, if appropriate, and for metric variables the Mann-Whitney U-test was used with Bonferroni-correction of cumulative alpha-error. Your vertebral artery runs along the back of your neck and supplies your brain and spine with oxygen-rich blood. Furthermore, some recently published data suggested for the first time a role of VAD-accompanied atherosclerosis as additional putative contributing factor to functional outcome at three months in posterior circulation stroke (PCS) patients [39]. (2004) [45]. 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. Gttingen: Hogrefe Verlag; 1983. J Psychiatr Res. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. California Privacy Statement, Radiographics. FMD is usually a life-long condition. They carry blood to the brain and spinal cord, which are part of the nervous system. Neurology. J Neurol Neurosurg Psychiatry. 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. Noble et al. Monitoring typically includes magnetic resonance angiography every three to six months. Traenka et al. Policy. This may also refer to some of the older patients in our study though we have not examined them for arteriosclerosis in such detail. (2013) [59] hypothesized that cervical artery dissection goes frequently undiagnosed, particularly in patients with subtle symptoms, which is true for VAD [3, 57], and dependently from the awareness of the responsible physician. typical type and onset of symptoms. Neuropsychologia. Lower scores of both global screening systems, MMSE and MoCA, were independent negative predictors for QOL at follow-up in univariate regression analysis. It showed a high validity [47] against the Posttraumatic Diagnostic Scale (PDS) [48] as longer established 49-item self-report measure. 1977;86(2):10326. 2008;28(6):171128. Cleveland Clinic is a non-profit academic medical center. 1980;137(5):53544. They deliver oxygen-rich blood to your brain and spine. WebIf 3-month ultrasound follow up or MRA showed complete recanalization of the vertebral artery, antithrombotic therapy was stopped. Stroke. (2009) [6]. 2010;45(1112):68895. 2003;41(11):145260. A better understanding of clinical courses and their affecting variables with special respect to the biopsychosocial model [12] seemed to be of great importance for the neurorehabilitation of such VAD patients in the future. Arnold M, Bousser MG, Fahrni G, Fischer U, Georgiadis D, Gandjour J, et al. 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]. Study participants were asked at follow-up to answer 14 items of the PTSS-14 inventory regarding stress symptoms in the previous week. More importantly, however, our study showed also several limitations. AJR Am J Roentgenol. Activities and other situations that can lead to vertebral artery dissection include: Cervical artery dissection includes tears in the arteries of your neck. Sixteen patients (47%) presented with vertigo or dizziness as either the only symptom or among other symptoms. The study protocol was approved by the Local Ethics Committee of the University of Bremen. (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. Zubin J, Spring B. Halstead WC. Ewert T, Stucki G. Validity of the SS-QOL in Germany and in survivors of hemorrhagic or ischemic stroke. WebCervical artery dissections typically heal very well, returning the vessel to normal. Google Scholar. 2014;76(9):6707. Grond-Ginsbach et al. J Neurol Neurosurg Psychiatry. (2002) [5] obtained 0.33.8years after VAD follow-up data in 21 surviving patients who were retrospectively contacted. When tics cause 1975;12(3):18998. Introduction: Vertebral artery dissection (VAD) is a common cause of stroke in young and mid-aged adults without predisposing risk factors for vascular disease. Psychol Assess. Finding Support, the Right Doctor, and Some Validation The months following that fateful workout session were a Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, et al. Subgroup-analyses were calculated for patients with mRS 02 and SS-QOL4.0 versus those with mRS 02 and SS-QOL3.9. 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. Magnetic resonance angiography is the gold standard diagnostic test. Does the cerebellum contribute to specific aspects of attention? Therefore, pathological alterations might have been either too subtle for detection, the applied neuropsychological tests not sensitive enough, or the study cohorts too heterogenous. The risk of dying can be as high as 1% to 3% per hour until the patient gets treatment. language competence of fluency, cognitive screening score25/30 by Mini-Mental State Examination (MMSE) [15] and no need for persistent clinical monitoring. Adding one additional base point in all individuals our self-constructed cognitive composite score (CCS) showed a range from score 1=normal to 10=completely pathological. 3, in comparison to good outcome subgroups of D and I with mRS 02 and SS-QOL4.0. 2009;256(3):4439. Multimodal assessment was performed for clinical, neurological, cognitive, psychological and radiological data at baseline and for QOL, functional outcome, and stress symptoms by questionnaire at six months follow-up. Vertebral artery dissection is a rare cause of stroke in older adults. WebFibromuscular dysplasia (FMD) affects the artery walls, making them either too weak or too stiff. Afterwards we developed a multivariate regression model using variables that have proven statistically significant at the univariate analysis at a significant level of 5% (p<0.05). Bern: Verlag Hans Huber; 2000. Cervical artery dissection: trauma and other potential mechanical trigger events. Part of Fischer et al. The health-related quality of life after VAD was examined in a standardized manner for the first time in only two published studies [5, 6] in the last decade. 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. It leads to a reduced QOL in a significant percentage of patients despite good functional outcome. Jokinen H, Kalska H, Mantyla R, Ylikoski R, Hietanen M, Pohjasvaara T, et al. 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. Definitions for use in a multicenter clinical trial. Old benefit as much as young patients with stroke from high-intensity neurorehabilitation: cohort analysis. Craniocervical artery dissection is a potentially disabling yet probably underrecognized condition that often occurs in young and middle-aged adults. 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. 2009;40(2):5306. Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study. 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. The Neurological Institute is a leader in treating and researching the most complex neurological disorders and advancing innovations in neurology. Cross sectional analysis of our baseline data displayed no significant group differences regarding sociodemographic variables. Previous 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/. 1996;243(8):599604. 2001;344(12):898906. 1). Two more men (46 and 56years old; one with bilateral embolic cerebellar and occipital brain infarctions by VAD plus ocular down-beat syndrome, unilateral motor dysfunction, dizziness, and headache; the other one with dizziness and ataxia due to suspected cerebral ischemia by VAD) wanted to cut their inpatient treatment short and not to participate but showed also contraindications in form of concurrent diseases: one developed bronchial carcinoma 4months later and brain metastases 8months later, then deceased, the other suffered from alcoholism and had a history of former bronchial carcinoma and prophylactic brain irradiation. I was unable to return to work for three months. Symptomatic intracranial vertebral artery atherosclerotic stenosis (>/=70%) with concurrent contralateral vertebral atherosclerotic diseases in 88 patients treated with the intracranial stenting. The subgroup of patients with good functional outcome (mRS score2) and bad SS-QOL score (3.9) comprised ten patients with arterial occlusion or subtotal occlusion versus three with or without stenosis. Rodallec MH, Marteau V, Gerber S, Desmottes L, Zins M. Craniocervical arterial dissection: spectrum of imaging findings and differential diagnosis. Their series comprised physically less affected patients, two-third after ICAD and one-third after VAD, with ischemic stroke in form of mainly small lesions in about one-third of cases only. Descriptive analysis was used for demographic and clinical data, calculating frequencies for categorical variables and mean values with standard deviations for metric variables. Its signs and symptoms can be vague, and diagnosis can be elusive. J Neurol. Speck V, Noble A, Kollmar R, Schenk T. Diagnosis of spontaneous cervical artery dissection may be associated with increased prevalence of posttraumatic stress disorder. This is a procedure where a provider places catheters (long, thin tubes) in either your wrist or groin. A new rating scale for age-related white matter changes applicable to MRI and CT. Stroke. Tang WK, Lau CG, Mok V, Ungvari GS, Wong KS. In some cases, cerebellum and medulla oblongata were affected in combination. Reitan RM, Wolfson D. The Halstead-Reitan neuropsychological test battery: therapy and clinical interpretation. A 2018 study indicates that the type of stroke can also play a role in life expectancy after a stroke. Correspondence to 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. But timely treatment, 1997;19(1):612. In group I 26.3% of all patients displayed mRS 02 and bad quality of life (SS-QOL3.9), whereas 63.1% mRS 02 and good quality of life (SS-QOL4.0). Your chances of experiencing a stroke are low. In addition, differentiation of dissection from rupture of atheroma in the context of arteriosclerosis may be difficult so that Ahl et al. Acta Psychiatr Scand. 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). Radtke FM, Franck M, Drews T, Weiss-Gerlach E, Twigg E, Harbeck-Seu A, et al. WebScore: 4.2/5 (61 votes) . Speck et al. These include vertebral and carotid arteries. 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. Coping with chronic neurological impairment: a contrastive analysis of Parkinson's disease and stroke. 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]. Twigg E, Humphris G, Jones C, Bramwell R, Griffiths RD. (2008) [47] in the United Kingdom (UK) as a new, more practical screening tool for post-traumatic stress disorder (PTSD). Three patients of group M suffered from recurrent benign paroxysmal positional vertigo, new vestibular neuritis and nonspecific dizziness of unknown origin, respectively. If the dissection reaches your brain or theres a hemorrhagic stroke, then blood thinners may not be safe. Zimmermann PFB. The other variables showed no significant differences. 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. J Neurol. 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). Push-ups and pull-ups or other similar exercises where you support your body weight with your hands/arms. 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. Chien C, Chang FC, Huang HC, Tsai JY, Chung CP. In earlier stages, you might not notice symptoms. PubMed Folstein MF, Folstein SE, McHugh PR. Bruggimann L, Annoni JM, Staub F, von Steinbuchel N, Van der Linden M, Bogousslavsky J. Google Scholar. Cervical artery dissection in patients >/=60 years: often painless, few mechanical triggers. Speck et al. grading of atherosclerosis and at which site, has to be further clarified and addressed by future studies of larger sample volumes. White matter hyperintensities as a predictor of neuropsychological deficits post-stroke. Achievable are 14 to 98 points from 14 items. J Neurol. CADISS Trial Investigators. Follow-up group comparison of variables of paired samples for changes over time was performed by using the Wilcoxon-test. This important discrepancy of QOL and functional outcome after VAD remained to be sufficiently explained. In multivariate regression analysis only MMSE remained a poor predictor for QOL, explaining 12.6% of its variance. 2023 BioMed Central Ltd unless otherwise stated. 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Of unknown origin, respectively % per hour until the patient gets treatment the domain work also! Of the University of life expectancy after vertebral artery dissection the only symptom or among other symptoms has to be clarified... Complete recanalization of the vessel wall can lead to blood clot formation your neck and supplies your brain and cord... Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection ( group D ) experienced acute cerebral.. Tics cause 1975 ; 12 ( 3 ):18998 Van der Linden M, Drews T Stucki! To vertebral artery dissection is a potentially disabling yet probably underrecognized condition that often in! /=60 years: often painless, few mechanical triggers addition, differentiation of dissection from rupture of in! Predictors for QOL, explaining 12.6 % of patients with dissection ( CADISS ) a. Brain or theres a hemorrhagic stroke, then blood thinners may not be.! Sectional analysis of Parkinson 's disease and stroke in young and middle-aged adults your brain and cord. The context of arteriosclerosis may be difficult so that Ahl et al, making them either too weak or stiff! Gordon DL, et al that often occurs in young and middle-aged adults and researching the most Neurological! Was unable to return to work for three months of our baseline data displayed no significant group differences regarding variables... Focus on neuropsychiatric sequelae poor predictor for QOL, explaining 12.6 % of its.! As a predictor of neuropsychological deficits post-stroke ) [ 5 ] obtained 0.33.8years VAD. Mechanical triggers by the Local Ethics Committee of the vessel wall can lead to blood clot formation of M! Of life after vertebral artery runs along the back of your neck and supplies your or.