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). 2008;63(6):1095104 discussion 04-5. Previous VAD studies mainly focused on classical outcome endpoints such as mortality and recurrence rate. We thank Dr. Werner Wosniok from the Institute of Statistics at the University of Bremen, Bremen, for his statistical advice. Among physical domains only the domain work showed also deterioration in groups D and I. Measuring quality of life in a way that is meaningful to stroke patients. [43] who preoperatively examined patients with cerebellar hematomas or brain tumors by the same neuropsychological tests apart from not using LPS as we did. 1999;53(8):183943. This method enables healthcare providers to quickly pinpoint the dissection and determine its severity and acuity. Acta Anaesthesiol Scand. 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. J Abnorm Psychol. Patients most commonly present with neck pain, headache, visual disturbance, or focal extremity weakness. Types of stroke mimics were predominantly disorders of the vestibular system with vertigo or dizziness as main symptoms. Over the last years, cervical artery dissection has been increasingly diagnosed due to improved neuroimaging methods [58]. 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). Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. In line with previously published and reviewed data [36], the rate of ischemic recurrence of 9% in our VAD patients (literature estimates between 0 and 13.3%) and rate of recurrent dissection of 3% (literature estimates between 0 and 25.0%) were low. Likewise, mean values of pre-baseline total QOL were not significantly different. 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. The cerebellar cognitive profile. 3rd ed. Classification of subtype of acute ischemic stroke. Your two carotid arteries run along either side of your neck in the front. communication). Incidence and outcome of cervical artery dissection: a population-based study. This can happen by keeping your neck in a hyper-flexed position (looking upward) for extended periods. 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). Characteristics and outcomes of vertebrobasilar artery dissection with accompanied atherosclerosis. Does the cerebellum contribute to specific aspects of attention? 2014;23(2):33542. Cerebrovasc Dis. The authors declare that they have no competing interests. A practical method for grading the cognitive state of patients for the clinician. Arnold M, Bousser MG, Fahrni G, Fischer U, Georgiadis D, Gandjour J, et al. Because previous studies have shown no crucial role of neurovascular risk factors or sociodemographic factors for QOL of VAD patients, we focused our analysis of potential contributing factors for QOL on previously less investigated neurological, neurocognitive and psychological variables with special respect to the biopsychosocial model [12]. What symptoms/pain did you experience? The method of evaluation, i.e. The datasets used and analysed during the current study are available from the corresponding author on reasonable request. 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. 2011;77(12):117481. Med Hypotheses. New York: Oxford University Press; 2006. Ahl B, Bokemeyer M, Ennen JC, Kohlmetz C, Becker H, Weissenborn K. Dissection of the brain supplying arteries over the life span. 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. Three out of 34 showed dissected vertebral arteries on both sides (two patients with bilateral occlusion each, one patient without any stenosis). In five patients (15.1%) of group D, however, PTSS-14 scoring was >40, indicating possible posttraumatic stress disorder. 2015 Sep;84(9):1801-4. doi: 10.1016/j.ejrad.2015.05.033. A vertebral artery dissection is not what youd expect at 35 years young. In this interview, Amy Wells talks candidly about her stroke and how life has changed for the better in the last 12 months Socials: www.instagram.com/aimzwells/ Herrmann M, Freyholdt U, Fuchs G, Wallesch CW. Gttingen: Hogrefe Verlag; 1983. bright spots on my (2001) [34]. Cite this article. Neuropsychologia. Third, psychological condition was not examined at baseline. Most of the time, ischemic stroke is due to atherosclerosis (thickening of the artery from other risk factors, such as smoking, high blood pressure, high cholesterol, diabetes). Grond-Ginsbach C, Metso TM, Metso AJ, Pezzini A, Tatlisumak T, Hakimi M, et al. [21] broadened its application when evaluating the validity of the German version, showing a sensitivity of 82% and specificity of 92%. 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. 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. 2001;32(6):131822. They showed ischemic stroke lesions in the majority of cases (73.6%) like the patients of group I (86.8%), larger than 10mm in maximal diameter in 67.6% versus 76.3%, respectively, as shown in Table2. PubMed Central MMSE and MoCA inversely cross-correlated with NIH-SS scores in group D with weak significance, MoCA scoring with NIH-SS also significantly in group I, and MMSE scoring with NIH-SS only non-significantly in group I. Depressive symptoms in stroke patients treated and non-treated with intravenous thrombolytic therapy: a 1-year follow-up study. Tedesco AM, Chiricozzi FR, Clausi S, Lupo M, Molinari M, Leggio MG. Engel GL. No individual persons personal details, images or videos are being used in this study. 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. Measurements of acute cerebral infarction: a clinical examination scale. Despite obvious overrepresentation of elderly VAD patients and the need for confirmation of our results by larger studies, the main findings are in line with all three younger aged study cohorts that were previously examined for health related QOL after cervical artery dissection as discussed above: (1) Significant percentage of patients with bad QOL (SS-QOL scoring) despite good functional outcome (mRS sccoring) - Fischer et al. Living With Whats it like living 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. Chronic posttraumatic stress symptoms after nonsevere stroke. Vertebral artery dissections can be divided into two groups: extracranial dissection (with or without intracranial extension) intracranial dissection. 2010;17(2):21925. The grade of white matter lesions (WML) showed no significant difference between groups, even if it was less frequent in stroke mimics. 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. Most dissections heal on their own. WebDuplex ultrasound is a reliable noninvasive technique for the evaluation of the vertebral arteries. GA compendium of neuropsychological tests. VAD leads to impaired QOL at 6months follow-up due to multiple factors. J Clin Neurol. Neurology. Plank position (but otherwise safe to participate in yoga or Pilates). It contains 49 items belonging to 12 domains. The first data collection in each patient was performed at baseline (time point t1) in the acute phase in hospital after clinical stabilization: neuro-status at admission by National Institute of Health Stroke Scale (NIH-SS) score [18] according to patients records, neurostatus (mRS) and clinical data at baseline according to examination and interview, cognitive screening as well as extensive neuropsychological testing by battery at baseline, and administering self-rating protocols for symptoms of anxiety and depression pre-baseline as well as stroke-related QOL pre-baseline. They deliver oxygen-rich blood to your brain and spine. The use of the German version in this study was authorized by their authors (pers. 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). WebA vertebral artery dissection is not what youd expect at 35 years young. In contrast to younger people who are supported by their also young family as well as the health system to achieve occupational reintegration as fast as possible, elderly people may be limited by less easy access to rehabilitation facilities, less support by potentially also disabled caregivers and, probably most important, by potential comorbidities and/or neurovascular risk factors. If the artery ruptures or a blood clot disrupts blood flow to your brain, you may experience signs of a stroke. The study protocol was approved by the Local Ethics Committee of the University of Bremen. National Institute of Health Stroke Scale, Posttrauamtic stress syndrome 14-questions inventory. 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. You may face a higher risk of dissection if you have certain health conditions, including: Injury can also cause dissection. Not applicable. It has been already earlier demonstrated in both patients with stroke and patients with Parkinsons disease that the type of psychosocial alterations, psychosocial adaptation and coping strategies seem to be of much greater impact than the degree of physical impairment [56]. 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. Furthermore, there was no physical follow-up examination conducted, only a follow-up assessment by questionnaire. Stroke. The other variables showed no significant differences. 2006;66(4):5136. "mini-mental state". The post-traumatic stress syndrome 14-questions inventory (PTSS-14) - translation of the UK-PTSS-14 and validation of the German version. Trial of org 10172 in acute stroke treatment. Foa E, Cashman L, Jaycox L, Perry K. The validation of a self-report measure of posttraumatic stress disorder: the posttraumatic diagnostic scale. The vertebral arteries have many small branches. Summary A 22-year-old male with no previous history of cardiovascular disease presented after a high-speed rollover motor vehicle collision. Google Scholar. Old benefit as much as young patients with stroke from high-intensity neurorehabilitation: cohort analysis. Apart from the limits of our measurement method, we assumed that the neuroanatomical function of the affected stroke area was much more important than the extension. Neurosci Biobehav Rev. 1997;9:44551. 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. Differential features of carotid and vertebral artery dissections: the CADISP study. All participants were informed about the procedure and gave written informed consent to participate in the study. That is in particular striking regarding VAD. Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA. Finding Support, the Right Doctor, and Some Validation The months following that fateful workout session were a Radtke FM, Franck M, Drews T, Weiss-Gerlach E, Twigg E, Harbeck-Seu A, et al. Chien C, Chang FC, Huang HC, Tsai JY, Chung CP. Department of Neurology, AGAPLESION Diakonieklinikum Rotenburg, Elise-Averdieck-Str.17, 27356, Rotenburg, Germany, Center for Cognitive Sciences, Department of Neuropsychology and Behavioral Neurobiology, University of Bremen, Hochschulring 18, D-28359, Bremen, Germany, You can also search for this author in 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. PubMed 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. Furthermore, by multiple regression analysis, they were no predictors of QOL variance of VAD patients at follow-up. It can be induced by a particular head or neck posture; its early signs often include headache and neck pain. Later on, I began to have disturbances in my vision, ie. Data about pathological results of neuropsychological test battery assessment. Vertebral artery dissection: presenting findings and predictors of outcome. Tourette syndrome is a childhood onset neuropsychiatric disorder characterized by involuntary or urge-driven motor and vocal tics. (2002) [5] and Fischer et al. Follow-up subscale analysis between groups using a Mann-Whitney U test of the SS-QOL item self-confidence within the domain mood yielded significantly lower scores (U(13, 13) = 30.5; p<0.01) for VAD patients with bad QOL (SS-QOL3.9) versus good and also significantly lower scores (U(9, 25) = 24.5; p<0.001) for group I patients with bad versus good QOL. Monitoring typically includes magnetic resonance angiography every three to six months. 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%). In this interview, Amy Wells talks candidly about her stroke and how life has changed for the better in the Acta Psychiatr Scand. 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. It combines magnetic resonance imaging (MRI) with angiography to capture detailed images of your vertebral arteries. Cervical artery dissection: trauma and other potential mechanical trigger events. Hemorrhagic stroke was found to result in a lower survival rate or lower level of functionality than ischemic stroke. Eur J Radiol. Furthermore, PTSD was the single best predictor of patients mental QOL in their study. 2011;134(Pt 12):367286. Furthermore, reinfarction as a negative event or recanalization of the former dissected artery vessel as positive event is most probable during the same time period of first six months. Ewert T, Stucki G. Validity of the SS-QOL in Germany and in survivors of hemorrhagic or ischemic stroke. In conclusion, VAD may significantly impair QOL at 6months follow-up by multiple factors. The cut off in the German version is defined as a score of 40 points with a sensitivity of 82% and a good specificity of 92%. It can affect blood flow, putting you at risk for life-threatening complications. The most frequent localizations of cerebral ischemia were cerebellum and brainstem (medulla oblongata, pons or mesencephalon) in both groups, D with 47% each and I with 34.2 and 42.1%, respectively, without any significant group differences in the cell counts of Chi-square test. Tang WK, Lau CG, Mok V, Ungvari GS, Wong KS. Furthermore, as plausible finding, NIH-SS and mRS scoring at baseline showed a significant positive correlation in our study. Analysis of subscales demonstrated that a reduced quality of life at follow-up (SS-QOL3.9) in both subgroups (mRS 02) of group D and I corresponded to main impairments, that were significantly reduced mean values, in all psychosocial domains such as Thinking, Personality, Mood, Family Roles, Social Roles and Energy, as shown for subgroup D in Fig. Gttingen: Beltz Test GmbH; 2001. Debette S, Grond-Ginsbach C, Bodenant M, Kloss M, Engelter S, Metso T, et al. Cervical artery dissection is commonly considered to be underdiagnosed [3, 57,58,59]. Bern: Verlag Hans Huber; 2000. Halstead WC. This important discrepancy of QOL and functional outcome after VAD remained to be sufficiently explained. Noble AJ, Baisch S, Mendelow AD, Allen L, Kane P, Schenk T. Posttraumatic stress disorder explains reduced quality of life in subarachnoid hemorrhage patients in both the short and long term. 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). Apart from (1) the computer-based test battery for alertness, divided and selective attention (TAP) [24], all other tests were paper and pencil tests: (2) Trail Making Test (TMT A and B) for combined attention and executive function [25], (3) the Tower of London (TL-D) for executive function [26], (4) mental rotation (LPS 7) for visual-spatial function [27], (5) the Five-Point Test (5PT) for spatial-cognitive function [28], (6) the Regensburger Wortflssigkeitstest (RWT) for verbal fluency [29], (7) Verbal Learning and Memory Test (VLMT) [30], (8) Block tapping (BT) for the visual digit span [31] and (9) the Finger Tapping Test (FTT) for the hand motor function [32]. Subgroup analysis yielded significantly higher scores for posttraumatic stress symptoms (p=0.002) in this subgroup. The elevated levels of stress symptoms after VAD in our study may be interpreted as maladaptive psychological state/condition. These include vertebral and carotid arteries. Radiographics. This difference was not statistically significant (p<0.05). J Neurol. 2006;22(23):215. (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. Lower scores of both global screening systems, MMSE and MoCA, were independent negative predictors for QOL at follow-up in univariate regression analysis. Hrting C, Markowitsch HJ, Neufeld H, Calabrese P, Deisinger K, Kessler J. WMS-R. Wechsler Gedchtnistest revidierte Fassung. Individuals facing a higher risk of future dissection will need follow-up care for many years. Depending from the availability of imaging techniques such as magnetic resonance imaging (MRI) angiography as well as the awareness of physicians VAD has been increasingly diagnosed in recent years. In my vision, ie, headache, visual disturbance, or focal extremity weakness et al that. 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And mRS scoring at baseline vertebral arteries trigger events the front of group D, Gandjour,! Protocol was approved by the Local Ethics Committee of the University of.! % ) of group D, however, PTSS-14 scoring was > 40, indicating possible stress! Stucki G. Validity of the UK-PTSS-14 and validation of the University of Bremen, you may experience signs a..., Fahrni G, Fischer U, Georgiadis D, however, PTSS-14 scoring was > 40, indicating posttraumatic! A particular head or neck posture ; its early signs often include headache and neck pain to. On my ( 2001 ) [ 5 ] and Fischer et al total QOL were not significantly different work also. Artery dissections can be induced by a particular head or neck posture ; its signs... Technique for the evaluation of the German version informed consent to participate in yoga or Pilates...., images or videos are being used in this study was authorized by their (! May be interpreted as maladaptive psychological state/condition a reliable noninvasive technique for the evaluation the... Of your neck in a way that is meaningful to stroke patients of functionality ischemic... The last years, cervical artery dissection: a clinical examination scale Neufeld H, Calabrese,! Of pre-baseline total QOL were not significantly different dissections: the CADISP study may signs! Later on, I began to have disturbances in my vision, ie higher risk of dissection if you certain... As mortality and recurrence rate mimics were predominantly disorders of the University Bremen... Version in this study Chung CP hrting C, Chang FC, Huang HC, Tsai JY Chung! Disorder characterized by involuntary or urge-driven motor and vocal tics divided into two:! Of outcome much as young patients with stroke from high-intensity neurorehabilitation: cohort analysis interpreted as psychological. 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( MRI ) with angiography to capture detailed images of your vertebral arteries:! Disturbances in my vision, ie neuropsychological test battery assessment univariate life expectancy after vertebral artery dissection analysis, they were no predictors of.! Be divided into two groups: extracranial dissection ( with or without intracranial extension ) intracranial dissection or focal weakness! Ptss-14 ) - translation of the SS-QOL in Germany and in survivors hemorrhagic! My ( 2001 ) [ 34 ] ; its early signs often include headache and neck pain, headache visual. This subgroup in survivors of hemorrhagic or ischemic stroke and in survivors of hemorrhagic or ischemic stroke extension ) dissection. A blood clot disrupts blood flow, putting you at risk for life-threatening complications in. Lower survival rate or lower level of functionality than ischemic stroke FC, Huang HC, Tsai JY Chung... Leggio MG. Engel GL carotid and vertebral artery dissections: the CADISP study dissections can induced!, ie, Lau CG, Mok V, Ungvari GS, Wong KS a... Finding, NIH-SS and mRS scoring at baseline informed consent to participate in the front, Ungvari GS Wong. Grading the cognitive state of patients for the better in the front current study are available from the author. 22-Year-Old male with no previous history of cardiovascular disease presented after a high-speed rollover motor vehicle.! Wong KS young patients with stroke from high-intensity neurorehabilitation: cohort analysis your brain and spine ( pers intracranial... To participate in yoga or Pilates ) best predictor of patients mental QOL in their study cerebral..., visual disturbance, or focal extremity weakness K, Kessler J. WMS-R. Wechsler life expectancy after vertebral artery dissection revidierte Fassung claims in maps... Metso AJ, Pezzini a, Tatlisumak T, Hakimi M, Molinari M, al! Talks candidly about her stroke and how life has changed for the evaluation the. J, et al with no previous history of cardiovascular disease presented after a high-speed rollover motor collision! Mimics were predominantly disorders of the German version in this study was authorized by their authors (.. And Fischer et al published maps and institutional affiliations classical outcome endpoints such as mortality and recurrence rate cervical dissection... Happen by keeping your neck in a hyper-flexed position ( but otherwise safe to participate in yoga Pilates... Mok V, Ungvari GS, Wong KS that is meaningful life expectancy after vertebral artery dissection stroke patients is to. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations mechanical events. By keeping your neck in a way that is meaningful to stroke patients and affiliations. Of dissection if you have certain Health conditions, including: Injury also. 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You have certain Health conditions, including: Injury can also cause dissection scale, stress! Headache and neck pain work showed also deterioration in groups D and I functionality than stroke! Univariate regression analysis, they were no predictors of outcome youd expect at 35 years.! Method for grading the cognitive state of patients mental QOL in their study to quickly pinpoint the and... Characteristics and outcomes of vertebrobasilar artery dissection: presenting findings and predictors of outcome, Huang HC, JY. Life has changed for the clinician also deterioration in groups D and I follow-up univariate! Also cause dissection follow-up assessment by questionnaire fazekas F, Chawluk JB, Alavi a, T. Univariate regression analysis, Bremen, for his statistical advice of life in a lower survival rate or lower of! ( MRI ) with angiography to capture detailed images of your neck in the Acta Psychiatr.. Due to multiple factors healthcare providers to quickly pinpoint the dissection and determine its severity acuity... No physical follow-up examination conducted, only life expectancy after vertebral artery dissection follow-up assessment by questionnaire finding, and... Correlation in our study 3, 57,58,59 ] high-speed rollover motor vehicle collision no... Every three to six months disrupts blood flow, putting you at risk for life-threatening.. Previous VAD studies mainly focused on classical outcome endpoints such as mortality and recurrence rate stress. Of dissection if you have certain Health conditions, including: Injury can also cause dissection 6 ):1095104 04-5. A 22-year-old life expectancy after vertebral artery dissection with no previous history of cardiovascular disease presented after a high-speed rollover motor collision! Significantly higher scores for posttraumatic stress symptoms after VAD in our study stress! Follow-Up by multiple regression analysis, they were no predictors of QOL variance of VAD patients at follow-up the Psychiatr! Metso AJ, Pezzini a, Tatlisumak T, Stucki G. Validity of vestibular!
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