Chicago: University of Chicago Press; 1947. Brain and intelligence: a quantitative study of the frontal lobes. J Neurol. 2014;45(11):33606. Ischemic stroke was found in only 33.9%. Its more common in people younger than 45. 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. 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. Vertebral artery dissection (VAD) may cause cerebral ischemia and impair quality of life (QOL) despite of good functional outcome. Comparison of cognitive baseline profiles of the three groups revealed no significant differences. In earlier stages, you might not notice symptoms. PubMed White matter hyperintensities as a predictor of neuropsychological deficits post-stroke. Toglia J, Fitzgerald KA, O'Dell MW, Mastrogiovanni AR, Lin CD. Williams LS, Weinberger M, Harris LE, Biller J. 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). Moreover, our data demonstrated no role of WML as independent predictor of QOL. Trends towards worse cognitive function without statistical significance were found in group D and I compared to group M for the following cognitive domains: divided and selective attention (TAP), combined attention and executive function (TMT A and B), mental rotation (LPS-7), and spatial cognitive function (FPT). Blood in the separated layers of the vessel wall can lead to blood clot formation. This difference was not statistically significant (p<0.05). PubMed Central 88.2% of patients with dissection (group D) experienced acute cerebral ischemia. 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. Depressive symptoms in stroke patients treated and non-treated with intravenous thrombolytic therapy: a 1-year follow-up study. Rainer J. Strege. Furthermore, it may sufficiently explain the predominant impairments of psychosocial QOL domains after VAD. Its signs and symptoms can be vague, and diagnosis can be elusive. Stroke. Psychosom Med. The mRS is considered to be the worldwide most established functional outcome measure after stroke. 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]. 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. Thomas LC, Rivett DA, Attia JR, Levi CR. BMC Neurol 19, 312 (2019). Part of Speck et al. By using this website, you agree to our WebMy wife had a vertebral artery dissection that caused a stroke in her brain stem almost three years ago. (2008) [55], for example, prospectively studied 105 subarachnoid hemorrhage patients at 3 and 13months post-ictus and found that 37 % met the diagnostic criteria of PTSD. Springer Nature. 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. Cervical artery dissection: trauma and other potential mechanical trigger events. Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): a randomised trial. 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. The cerebellar cognitive profile. The senior age of VAD patients may have several important implications for social life. Gttingen: Hogrefe Verlag; 2004. 2006;67(10):180912. Engel GL. Czechowsky D, Hill MD. 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. [13] and in the context of a fitting medical history, i.e. (2009) [6]. Bern: Verlag Hans Huber; 2000. Article Study participants were asked at follow-up to answer 14 items of the PTSS-14 inventory regarding stress symptoms in the previous week. 2013;80(21):19507. AJR Am J Roentgenol. 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. Mean age was 52.5 9.6 years and 91% were women (57% were post-menopausal). 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. 2017;88(14):131320. Article The risk of dying can be as high as 1% to 3% per hour until the patient gets treatment. It showed a high validity [47] against the Posttraumatic Diagnostic Scale (PDS) [48] as longer established 49-item self-report measure. They finally hypothesized that the rate of incidence must be equal throughout life. Stroke. Measuring quality of life in a way that is meaningful to stroke patients. Neurology. Cervical artery dissection, including VAD and carotid artery dissection, are rare complications of pregnancy. In accordance with common convention, mRS score of 02 reflects a good functional status meaning independency in daily living. The data suggest that posttraumatic stress symptoms are of significant importance for the QOL after VAD. Coping with chronic neurological impairment: a contrastive analysis of Parkinson's disease and stroke. J Abnorm Psychol. The variance of total QOL was determined by neurological, neurocognitive and psychological predictive factors. Theyll use contrast dye and X-ray-guided imaging to look at blood flow through the artery itself along with the extent of the dissection or vessel injury in real-time. Maximum scores of 30 points in each of both tests correspond to an unimpaired cognition. Five-point test. 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. Other activities with rapid acceleration/deceleration changes. 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. Furthermore, there was no physical follow-up examination conducted, only a follow-up assessment by questionnaire. Chronic posttraumatic stress symptoms after nonsevere stroke. 2005;1(1):5968. Impairments in neurocognitive screening tests (MMSE, MoCA) correlated weakly with neurological impairments as measured by NIH-SS. 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 Auflage. 2012;13:164. Plank position (but otherwise safe to participate in yoga or Pilates). Individuals facing a higher risk of future dissection will need follow-up care for many years. This exploratory study was carried out in the Neurological Department of the University-affiliated teaching hospital AGAPLESION Diakonieklinikum Rotenburg, Germany. Kim JS, Choi-Kwon S, Kwon SU, Lee HJ, Park KA, Seo YS. 2005;76(9):122933. J Neurol Neurosurg Psychiatry. Neurology. 2023 BioMed Central Ltd unless otherwise stated. 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. (2002) [5] and Fischer et al. 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. But its still a dangerous situation. In addition, the autopsy findings of the 66years old patient with medulla oblongata infarction by VAD who deceased due to unexpected heart failure after baseline confirmed the diagnosis of VAD and support the validity of our data. A practical method for grading the cognitive state of patients for the clinician. Because recurrence of stroke or dissection is very low despite a mostly lacking morphological artery recanalization and it is nearly limited to the first weeks after dissection, it was questioned by Leys and Debette (2006) [4] what are the appropriate clinical monitoring parameters for follow-up. bright spots on my Tourette syndrome is a childhood onset neuropsychiatric disorder characterized by involuntary or urge-driven motor and vocal tics. Quality of life in survivors after cervical artery dissection. 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. A new rating scale for age-related white matter changes applicable to MRI and CT. Stroke. Sixteen patients (47%) presented with vertigo or dizziness as either the only symptom or among other symptoms. A total of 327 patients were enrolled from 2012-2106. (2004) [58] showed in their study that a significant number of cervical artery dissection can occur in the older age group and can be diagnosed if considered. GA compendium of neuropsychological tests. (2009) [6]. Turm von London Deutsche Version. J Neurol. 2008;52(2):2028. Arch Phys Med Rehabil. Lower scores of both global screening systems, MMSE and MoCA, were independent negative predictors for QOL at follow-up in univariate regression analysis. Later on, I began to have disturbances in my vision, ie. SS-QOL-subgroup analysis of patients with dissection and mRS score 02 at follow-up, SS-QOL Stroke Specific Quality Of Life; mRS modified Rankin Scale. 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. A dissection is a tear in one or more tissue layers that make up your vertebral artery. Otherwise, antithrombotic therapy was Among physical domains only the domain work showed also deterioration in groups D and I. The latter one was also used to determine the functional outcome at follow-up, filled out by the patient. WebScore: 4.2/5 (61 votes) . Table4 shows univariate linear regression analysis demonstrating that neurocognition scores at baseline (MMSE, MoCA, CCS), neurostatus at baseline (NIH-SS score on admission, mRS score) and stress symptoms at follow-up (PTSS-14 score) were predictors of quality of life at follow-up. 3rd ed. (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. 2003;41(11):145260. 2003;250(10):117984. With carotid dissection, the dissection rarely goes completely through the artery due to its elastic outer layers. 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. Stroke. The PTSS-14 was developed by Twigg et al. This profile of cognitive dysfunction was related to predominance of cerebellar stroke lesions in both group D and group I. Other sites of ischemia were occipital lobe in 17.6% of group D and 34.2% of group I, furthermore thalamus in 5.3% of group I. 2002;13(3):1927. Therefore, mRS scoring of 02 at follow-up was used as a good functional outcome. Previous studies described poststroke cognitive decline by global cognitive screening such as MMSE and more recently and more sensitively by MoCA [42]. Measurements of acute cerebral infarction: a clinical examination scale. Practicing yoga where hyperextension of your neck occurs. All participants were informed about the procedure and gave written informed consent to participate in the study. Neurosurgery. 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. 2017;7(3):16572. Patients most commonly present with neck pain, headache, visual disturbance, or focal extremity weakness. Cerebrovasc Dis Extra. 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. Living With Whats it like living In recent years, however, patient-centered outcome measures such as quality of life (QOL) gained increasing importance. 2014;23(2):33542. Hrting C, Markowitsch HJ, Neufeld H, Calabrese P, Deisinger K, Kessler J. WMS-R. Wechsler Gedchtnistest revidierte Fassung. 3, in comparison to good outcome subgroups of D and I with mRS 02 and SS-QOL4.0. 1980;137(5):53544. Neurology. 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. 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. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. 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. (2014) [46] were the only other ones to date who recently published cognitive status data of patients after cervical artery dissection. WebDuplex ultrasound is a reliable noninvasive technique for the evaluation of the vertebral arteries. Psychometric self-rating tools, as used in this study, may enable timely detection of such sequelae and facilitate therapeutic intervention. 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. 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. 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). Advertising on our site helps support our mission. In a subsequent multiple regression analysis, neurocognition at baseline measured by MMSE, neurostatus at baseline measured by mRS and posttraumatic stress symptoms measured by PTSS-14 proved to be independent predictors for the quality of life at follow-up, explaining in combination 71% of its variance. Endovascular therapy versus intravenous thrombolysis in cervical artery dissection ischemic stroke - results from the SWISS registry. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. (2009) [6] who assumed mean SS-QOL in all their study patients before dissection as best measure for a good QOL. 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. Dissection in either artery can disrupt blood flow and potentially cause a stroke. Summary A 22-year-old male with no previous history of cardiovascular disease presented after a high-speed rollover motor vehicle collision. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2588305/). Vertebral artery dissection: natural history, clinical features and therapeutic considerations. Intra-arterial dose: 0.3 mg/kg; not to exceed 10-20 mg . Subgroup analysis yielded significantly higher scores for posttraumatic stress symptoms (p=0.002) in this subgroup. Zigmond AS, Snaith RP. WebMethods: Clinical and radiological data of 114 patients with sCAD were collected prospectively. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, (https://www.ncbi.nlm.nih.gov/books/NBK441827/). Vulnerability--a new view of schizophrenia. Vertebral and carotid artery dissections account for only 2% of ischemic strokes. In this interview, Amy Wells talks candidly about her stroke and how life has changed for the better in the Third, psychological condition was not examined at baseline. These include vertebral and carotid arteries. 8. (2001) [34]. Furthermore, the study design was limited: Most data were retrospectively collected and cognitive variables not examined, for example. WebFibromuscular dysplasia (FMD) affects the artery walls, making them either too weak or too stiff. 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. Exner C, Weniger G, Irle E. Cerebellar lesions in the PICA but not SCA territory impair cognition. 2004;251(10):12428. 2010;17(2):21925. 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. MoCA, to our best knowledge, was used in our study for the first time in VAD patients. Characteristics and outcomes of vertebrobasilar artery dissection with accompanied atherosclerosis. 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/ CAS The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. Fischer et al. 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. A 2018 study indicates that the type of stroke can also play a role in life expectancy after a stroke. WebCervical artery dissection, including carotid and vertebral artery dissection, has an estimated incidence of 3.54.5 per 100 000. 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. They argued that a systematic follow-up of the vascular lesions may induce anxiety both in patients and physicians and lead to inappropriate treatments. Neurocognitive domain assessment at baseline was dichotomized into normal versus pathological values based on a difference of more than one standard deviation. J Neurol. TOAST. 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. Jokinen et al. Three initially included woman of ages 70, 71, and 77years had to be excluded secondarily because of concurrent diseases in form of preexisting idiopathic cerebellar syndrome, acute symptomatic anterior circulation brain infarction, and predominant arteriitis temporalis (first with ocular disorder, paresis of arm, ataxia, and dysarthria plus suspected brainstem infarction due to VAD; second with VAD and arm paresis; third with VAD and visual field disorder). Twenty-three patients with VAD had (subtotal) occlusion, eight patients a stenosis and three no significant stenosis. Therefore, pathological alterations might have been either too subtle for detection, the applied neuropsychological tests not sensitive enough, or the study cohorts too heterogenous. All participants have given written informed consent. Psychological variables such as pre-baseline symptoms of anxiety and depression were not significantly different between our groups. RK contributed to the experimental design and manuscript writing. Our data suggest that posttraumatic stress symptoms are of significant importance for the QOL after VAD, in particular in patients with reduced QOL despite good functional outcome. Main life expectancy after vertebral artery dissection, spontaneous and traumatic, Weniger G, Irle E. cerebellar lesions in the neurological Department the., only a follow-up assessment by questionnaire artery dissection, are rare complications of pregnancy to its outer! Of stroke can also play a role in life expectancy after a high-speed rollover motor vehicle.... 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