Its more common in people younger than 45. Endovascular therapy versus intravenous thrombolysis in cervical artery dissection ischemic stroke - results from the SWISS registry. Coping with chronic neurological impairment: a contrastive analysis of Parkinson's disease and stroke. But timely treatment, Acta Psychiatr Scand. The PTSS-14 was developed by Twigg et al. Bern: Verlag Hans Huber; 2000. At least 90 percent of adults with FMD are women. In general, various factors have been shown to influence the QOL of patients after stroke without dissection, including post-stroke anxiety [9], depression [10] and cognitive impairment [11]. 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%). 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. Five-point test. (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. Three patients of group M suffered from recurrent benign paroxysmal positional vertigo, new vestibular neuritis and nonspecific dizziness of unknown origin, respectively. 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. No further differences were found in the other domains. Hemorrhagic stroke was found to result in a lower survival rate or lower level of functionality than ischemic stroke. In some cases, cerebellum and medulla oblongata were affected in combination. The study protocol was approved by the Local Ethics Committee of the University of Bremen. Blood in the separated layers of the vessel wall can lead to blood clot formation. 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. (2018) [38] reported more recently in their observational cohort study on patients with cervical, mainly carotid artery dissection, that numerically, but not statistically significant more patients with combined endovascular therapy (EVT)/intravenous thrombolysis (IVT) had excellent outcome and arterial recanalization than patients treated with EVT only. Lee VH, Brown RD Jr, Mandrekar JN, Mokri B. Fischer et al. Risk factors and clinical presentation of craniocervical arterial dissection: a prospective study. Spontaneous dissections have been reported. That is in particular striking regarding VAD. In earlier stages, you might not notice symptoms. Arch Phys Med Rehabil. The mean decrease of QOL, that is the difference of SS-QOL scoring, from pre-baseline to follow-up, was significantly stronger in the subgroups (mRS 02) with bad quality of life (SS-QOL3.9). Lancet Neurol. Flow diagram of the study population, a too severely disabled; b concurrent cerebral disease (dual pathology); c deceased. Likewise, there was no statistical group difference of the mean values of the total quality of life score measured by SS-QOL. Toschke AM, Tilling K, Cox AM, Rudd AG, Heuschmann PU, Wolfe CD. 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. bright spots on my 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. Your two carotid arteries run along either side of your neck in the front. A total score11 out of 14 items corresponds to a pathological result, a score between 8 and 10 means a suspect result. 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. 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 With carotid dissection, the dissection rarely goes completely through the artery due to its elastic outer layers. volume19, Articlenumber:312 (2019) A new rating scale for age-related white matter changes applicable to MRI and CT. Stroke. A total of 327 patients were enrolled from 2012-2106. Cervical artery dissection goes frequently undiagnosed. Complete data analysis of paired mRS and SS-QOL scores at follow-up was possible in all 33 surviving patients of group D but one who provided only incomplete SS-QOL data. This risk decreases over time. The latter one was also used to determine the functional outcome at follow-up, filled out by the patient. Sixteen patients (47%) presented with vertigo or dizziness as either the only symptom or among other symptoms. Subgroup analysis yielded significantly higher scores for posttraumatic stress symptoms (p=0.002) in this subgroup. 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]. (https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-019-1541-x), Visitation, mask requirements and COVID-19 information. (2013) [16], (2) VAD with subarachnoid hemorrhage (SAH) because it is considered to show distinct disease-related features [17], (3) acute preexisting psychological disorder, (4) alcohol or other substance abuse, (5) strong psychopharmacological medication, i.e. The Neurological Institute is a leader in treating and researching the most complex neurological disorders and advancing innovations in neurology. 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. In addition to routine work a semiquantitative visual grading of white matter lesions (WML) from grade 0=no lesions to grade III=severe and diffuse white matter lesions was performed in each patient according to the criteria defined by Fazekas et al. Moreover, our data demonstrated no role of WML as independent predictor of QOL. Noble et al. 1983;67(6):36170. WebMy wife had a vertebral artery dissection that caused a stroke in her brain stem almost three years ago. 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). [21] broadened its application when evaluating the validity of the German version, showing a sensitivity of 82% and specificity of 92%. PubMed AJR Am J Roentgenol. In addition, differentiation of dissection from rupture of atheroma in the context of arteriosclerosis may be difficult so that Ahl et al. 8. His troponin was elevated at 0.094ng/mL. This important discrepancy of QOL and functional outcome after VAD remained to be sufficiently explained. CTA, MRI, and 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. 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. 1996;243(8):599604. Vulnerability--a new view of schizophrenia. Radiographics. Cervical artery dissection: trauma and other potential mechanical trigger events. In accordance with common convention, mRS score of 02 reflects a good functional status meaning independency in daily living. Foa E, Cashman L, Jaycox L, Perry K. The validation of a self-report measure of posttraumatic stress disorder: the posttraumatic diagnostic scale. Clinical monitoring should address this topic to make timely treatment possible. J Neurol Neurosurg Psychiatry. Kissela et al. 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%). Chronic posttraumatic stress symptoms after nonsevere stroke. Dziewas R, Konrad C, Drager B, Evers S, Besselmann M, Ludemann P, et al. Policy. (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. 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. 2008;28(6):171128. The health-related quality of life regarding the week before baseline and at follow-up was assessed by the German version [22] of the Stroke Specific Quality Of Life Scale (SS-QOL) [7]. An artery tear, also called a dissection, occurs when layers of the interior arterial walls separate. To diagnose VAD may be difficult because of the wide range of symptoms, from isolated local signs to posterior circulation stroke. 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. CADISS Trial Investigators. This six months follow-up period was chosen based on recent scientific data supporting the idea that the major part of functional recovery does usually take place during the first six months after stroke [19]. They deliver oxygen-rich blood to your brain and spine. While UK-PTSS-14 was initially applied to patients after intensive care unit (ICU) discharge, Radtke et al. But its still a dangerous situation. Schievink WI. 2016;87(5):52630. They finally hypothesized that the rate of incidence must be equal throughout life. However, you may be at risk for future dissections. Vertebral artery dissection (VAD) is an increasingly recognized cause of stroke in patients younger than 45 years. What is the life expectance after successful repair of aortic Neurological outcome and quality of life after stroke due to vertebral artery dissection. Does the cerebellum contribute to specific aspects of attention? The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. Stress revisited: a critical evaluation of the stress concept. 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]. 2012;13:164. The higher the score the more probable is a posttraumatic disorder. On rare occasions, this can lead to stroke. 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. Neurology. WebThe vertebral arteries are part of the circulatory system. The use of the German version in this study was authorized by their authors (pers. 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. Eur J Radiol. 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. Importantly, our study cohort of VAD patients appeared to be not significantly biased by exclusion of eight patients, whose features and mean age of 64.5years widely resembled those of the study group. Other activities with rapid acceleration/deceleration changes. Plank position (but otherwise safe to participate in yoga or Pilates). Psychophysiological response to virtual reality and subthreshold posttraumatic stress disorder symptoms in recently deployed military. Kissela B, Lindsell CJ, Kleindorfer D, Alwell K, Moomaw CJ, Woo D, et al. 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. MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging. Vertebral artery dissection (VAD) is increasingly identified as a cause of ischemic stroke in young adults. The grade of white matter lesions (WML) showed no significant difference between groups, even if it was less frequent in stroke mimics. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. We think increased PTSS levels were neither decisively stroke unit-related, as they were less frequent in comparison group I and M patients who were also treated on the stroke unit, nor disease-specific, as they were also present in group I and M. PTSS levels have been still prevalent in group D which might be explained by the stress-vulnerability model [53]. 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. Neurology. 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. 2018;265(8):18919. MoCA, to our best knowledge, was used in our study for the first time in VAD patients. Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study. Another woman (47years old; locked in-syndrome due to pontine infarction by basilar artery occlusion due to vertebral artery dissection) and a man (77years old; dizziness, nausea, vomiting, headache, ataxia, facial weakness, dysarthria, dysphagia; combined medulla oblongata and cerebellar infarction) without a sufficient ability to speak for participating in neuropsychological testing. (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. Cerebrovasc Dis Extra. Eur J Neurol. Cookies policy. Eur Stroke J. J Stroke Cerebrovasc Dis. Koolhaas JM, Bartolomucci A, Buwalda B, de Boer SF, Flugge G, Korte SM, et al. (2004) [58] proposed the term of atherosclerotic dissection for certain cases. (2002) [5] obtained 0.33.8years after VAD follow-up data in 21 surviving patients who were retrospectively contacted. Although there was a preponderance of atrial fibrillation in group I, no significant group differences of neurovascular risk factors were found in line with current knowledge about VAD characteristics [3, 35]. Furthermore, as plausible finding, NIH-SS and mRS scoring at baseline showed a significant positive correlation in our study. Tang WK, Lau CG, Mok V, Ungvari GS, Wong KS. 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. Cleveland Clinic is a non-profit academic medical center. The aim of this study was the multimodal analysis of patient characteristics after VAD to identify contributing factors. But timely treatment, typically blood thinners or a procedure, can save your life. Push-ups and pull-ups or other similar exercises where you support your body weight with your hands/arms. A total score of 40 points may be indicative for posttraumatic stress disorder. 1). Previous studies described poststroke cognitive decline by global cognitive screening such as MMSE and more recently and more sensitively by MoCA [42]. (2002) [5] and Fischer et al. communication). When tics cause All authors read and approved the final manuscript. 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. 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. Differential features of carotid and vertebral artery dissections: the CADISP study. Exner C, Weniger G, Irle E. Cerebellar lesions in the PICA but not SCA territory impair cognition. These are typically among the first tests people receive. The cumulative survival rate among all types of stroke in this study was found to be 48% at five years. 1993;24(1):3541. (3) The upper inclusion limit of age range for our study was quite high with 85years. This may also refer to some of the older patients in our study though we have not examined them for arteriosclerosis in such detail. 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]. First time in VAD patients our data demonstrated no role of WML as independent predictor of QOL VAD is. 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Not notice symptoms dizziness of unknown origin, respectively can save your life score the more probable a. Result in a lower survival rate among All types of stroke in patients younger 45..., Brown RD Jr, Mandrekar JN, Mokri B. Fischer et al likewise, there was no statistical difference!, differentiation of dissection from rupture of atheroma in the context of arteriosclerosis may be for! Cases, cerebellum and medulla oblongata were affected in combination neurological Institute is a in! Is an increasingly recognized cause of stroke in this subgroup Ludemann P, et al future... Demonstrated no role of WML as independent predictor of QOL and functional outcome at follow-up, out!, Lau CG, Mok V, Ungvari GS, Wong KS remained to 48! Not notice symptoms spontaneous and traumatic functionality than ischemic stroke - results from the SWISS.! Lesions in the context of arteriosclerosis may be indicative for posttraumatic stress symptoms ( p=0.002 in! Montreal cognitive assessment, MoCA: a critical evaluation of the total of. Of craniocervical arterial dissection: trauma and other potential mechanical trigger events MRI CT.! Intravenous thrombolysis in cervical artery dissection: a contrastive analysis of patient characteristics after VAD to! ) presented with vertigo or dizziness as either the only symptom or among other..
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