On rare occasions, this can lead to stroke. 2005;53(4):6959. White matter hyperintensities as a predictor of neuropsychological deficits post-stroke. Living With Whats it like living Characteristics and outcomes of vertebrobasilar artery dissection with accompanied atherosclerosis. The data suggest that posttraumatic stress symptoms are of significant importance for the QOL after VAD. For the assessment of psychological variables several self-rating measurement tools were introduced: The German version of the Hospital Anxiety and Depression Scale (HADS) [20] was administered at baseline to determine the grade of symptoms of anxiety and depression in the week before baseline. Article The prevalence of 73.6% VAD patients with ischemic stroke and 14.7% with TIA in our study corresponded well to 67% (114 patients) and 10% (17 patients), respectively, in a large European multicenter prospective study on patients with first-ever spontaneous VAD [3]. Stress revisited: a critical evaluation of the stress concept. Cite this article. California Privacy Statement, Group-related mean values were below this cut-off level and not significantly different between groups: group D 27.1513.10, group I 23.848.74, and group M 26.129.55. Use of a screening questionnaire for post-traumatic stress disorder (PTSD) on a sample of UK ICU patients. It showed a high validity [47] against the Posttraumatic Diagnostic Scale (PDS) [48] as longer established 49-item self-report measure. 2014;45(11):33606. WebDuplex ultrasound is a reliable noninvasive technique for the evaluation of the vertebral arteries. This risk decreases over time. 2007;21(2):1618. MoCA, to our best knowledge, was used in our study for the first time in VAD patients. WebFibromuscular dysplasia (FMD) affects the artery walls, making them either too weak or too stiff. Webcoronary artery dissection is a potential life-threatening complication of blunt chest trauma. Vertebral artery hemodynamics can be evaluated by assessing: (1) the presence or absence of flow, (2) blood flow direction and alteration of the waveform shape, (3) vertebral artery size, and (4) the peak systolic and end-diastolic velocities. Stroke. According to modern stress concepts, situations that in particular include unpredictability and uncontrollability can trigger stress [54]. 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. Vertebral and carotid artery dissections account for only 2% of ischemic strokes. Zubin J, Spring B. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, (https://www.ncbi.nlm.nih.gov/books/NBK441827/). Chronic posttraumatic stress symptoms after nonsevere stroke. Web2. This important discrepancy of QOL and functional outcome after VAD remained to be sufficiently explained. The type of cause for ischemia in the group I was categorized according to the TOAST criteria [14]. The use of the German version in this study was authorized by their authors (pers. Neurosurgery. This option is also for people with hemorrhagic stroke. (2009) [6]. Individuals facing a higher risk of future dissection will need follow-up care for many years. This can lead to serious complications, including arterial narrowing (stenosis), weakening/bulging (aneurysm) or tearing (dissection). (2004) [58] proposed the term of atherosclerotic dissection for certain cases. Inpatient rehabilitation for several weeks was performed in 48.5% patients of group D, 60.5% of group I and in only one patient (4%) of group M. A change of employment at baseline to unemployment at follow-up was reported in 3 patients (9.4%) in group D, 5 patients (13.5%) in group I and 2 patients in group M. Figure2 displays group-related change of mRS scoring between baseline and follow-up: Mean mRS scores of about 2 at baseline were significantly higher (p<0.05) in group D and I in comparison to group M, reflecting a reduced functional status. WebWang ZL, Gao BL, Li TX, Cai DY, Zhu LF, Bai WX, Xue JY, Li ZS. 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. Helmstaedter C, Lendt M, Lux S. Verbaler Lern- und Merkfhigkeitstest (VLMT). Clinical assessment of data on hypertension (history or systolic arterial blood pressure>140mmHg or diastolic arterial blood pressure>90mmHg), diabetes mellitus, dyslipidemia (LDL>155mg/dl and/or HDL<35mmHg), and atrial fibrillation was performed at baseline. Google Scholar. Comparison of cognitive baseline profiles of the three groups revealed no significant differences. 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. Part of For both future research and clinical treatment, our data favor a multidimensional monitoring after VAD, with special focus on neuropsychiatric sequelae. There was a high responder rate in follow-up assessments: follow-up data were obtained in 97% of patients in group D, 100% in group I, and 96% in group M. Secondary ischemia prevention by medication until follow-up was provided by platelet aggregation inhibitors in 76.5% patients of group D and 81.6% of group I and oral anticoagulants in 23.5% patients of group D and 18.4% of group I. Vascular events of importance occurred until follow-up time point as follows: In group D one recurrent stroke, one suspected stroke, one new stroke due to dissection of the internal carotid artery, and one transient ischemic attack. Herzogenrath: Vera Fimm; 2009. Reitan RM, Wolfson D. The Halstead-Reitan neuropsychological test battery: therapy and clinical interpretation. In multivariate regression analysis only MMSE remained a poor predictor for QOL, explaining 12.6% of its variance. A total score11 out of 14 items corresponds to a pathological result, a score between 8 and 10 means a suspect result. 2010;17(2):21925. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2588305/). Article Furthermore, by multiple regression analysis, they were no predictors of QOL variance of VAD patients at follow-up. Corresponding to their multivariate analysis, the NIH-SS score on admission was also found to be an independent predictor of QOL at follow-up in our univariate regression analysis. Administration, norms, and commentary. Stroke. A 2018 study indicates that the type of stroke can also play a role in life expectancy after a stroke. 2001;344(12):898906. 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. 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. Get useful, helpful and relevant health + wellness information. I was unable to return to work for three months. In addition, the extent of WML showed a significant inverse correlation to global cognitive functioning (MMSE, MoCA) in group D and partly (MoCA only) in group M. Finally, more extensive stroke lesions correlated very weakly with stronger neurological impairment (higher NIH-SS score at baseline) in group D and showed no other consistent correlations. Does the cerebellum contribute to specific aspects of attention? Acta Psychiatr Scand. WebVertebral artery dissection occurs when a tear forms in one of the blood vessels running up the back of your neck. Summary A 22-year-old male with no previous history of cardiovascular disease presented after a high-speed rollover motor vehicle collision. Therefore, mRS scoring of 02 at follow-up was used as a good functional outcome. Predictors for QOL at follow-up were analyzed by regression model. 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%). All groups (D, I, and M) displayed a significant correlation between age and white matter lesions (WML). 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. But timely treatment, typically blood thinners or a procedure, can save your life. AJR Am J Roentgenol. Gttingen: Beltz Test GmbH; 2001. Chien C, Chang FC, Huang HC, Tsai JY, Chung CP. The latter one was also used to determine the functional outcome at follow-up, filled out by the patient. Chicago: University of Chicago Press; 1947. (2005) [41], for example, noted a correlation of the degree of WML with cognitive decline. MH contributed to the experimental design, data analyses and manuscript writing. Tucson: Neuropsychological Press; 1985. Up to 25% of stroke cases in this age group are due to vertebral artery dissection. PubMed Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. Aschenbrenner S, Tucha O, Lange KW. 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. (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. 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. Cerebral ischemia in group I patients was caused by cardiac embolism in 34.2%, lacunar disease in 21%, large artery disease in 10.5% and by undetermined cause in 34.2% according to the TOAST-criteria [14]. In our study, there was a trend in patients with good functional outcome (mRS score 02) to higher association of occlusion/subtotal occlusion with worse QOL, though this was statistically nonsignificant (p<0.05). WebA vertebral artery dissection is not what youd expect at 35 years young. The method of evaluation, i.e. 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. Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, et al. By using this website, you agree to our Magnetic resonance angiography is the gold standard diagnostic test. 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]. Patients most commonly present with neck pain, headache, visual disturbance, or focal extremity weakness. 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. bright spots on my 2. 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. Types of stroke mimics were predominantly disorders of the vestibular system with vertigo or dizziness as main symptoms. It leads to a reduced QOL in a significant percentage of patients despite good functional outcome. Traenka C, Dougoud D, Simonetti BG, Metso TM, Debette S, Pezzini A, et al. Eur Stroke J. You may face a higher risk of dissection if you have certain health conditions, including: Injury can also cause dissection. Google Scholar. Cervical artery dissection, including VAD and carotid artery dissection, are rare complications of pregnancy. Painting a ceiling with your neck in an extended position for a long time. 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. 2001;32(6):131822. Mean age was 52.5 9.6 years and 91% were women (57% were post-menopausal). Not applicable. A practical method for grading the cognitive state of patients for the clinician. Another 66years old patient with medulla oblongata infarction deceased due to nonspecific heart failure and was lost for follow-up; in group I one stroke and two myocardial infarcts occured; group M remained without any vascular event. 2013;80(6):78790. J Stroke Cerebrovasc Dis. 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. Coil Embolization for the Treatment of Ruptured Dissecting Vertebral Aneurysms. 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. Springer Nature. 2013;80(21):19507. All authors read and approved the final manuscript. All participants have given written informed consent. That is in particular striking regarding VAD. 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. Follow-up group comparison of variables of paired samples for changes over time was performed by using the Wilcoxon-test. statement and First of all, the study cohort showed an unusual high percentage of elderly VAD patients (mean age 62.611.9). Even if WML predominated in groups D and I compared to stroke mimics, they showed no significant inter-group difference. CADISS Trial Investigators. Radiographics. Correspondence to Cervical artery dissection: trauma and other potential mechanical trigger events. Sometimes, your healthcare provider may recommend conventional angiography. Stroke. Finding Support, the Right Doctor, and Some Validation The months following that fateful workout session were a 2004;75(8):11946. Ahl B, Bokemeyer M, Ennen JC, Kohlmetz C, Becker H, Weissenborn K. Dissection of the brain supplying arteries over the life span. Second, apart from elevated scores of stress symptoms, significantly higher scores of pre-baseline symptoms of anxiety were found which might be indicative for a predisposing vulnerability for anxiety disorders and subtypes like (subthreshold) posttraumatic stress disorder. Vertebral artery dissection (VAD) may cause cerebral ischemia and impair quality of life (QOL) despite of good functional outcome. Vertebral artery dissection (VAD) is a rare cause of stroke in the general population; however, represents one of the more common causes of stroke in patients younger than 45 years of age. 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. It generates 12 domain-related scores and a total score. 2004;251(10):12428. 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. J Clin Neurol. Activities and other situations that can lead to vertebral artery dissection include: Cervical artery dissection includes tears in the arteries of your neck. 2003;41(11):145260. Finally, additional potential outcome-relevant lifestyle-factors such as nutrition and sports activity as well as social factors such as social networks and social support were not taken into account of this study. WebWhat is the life expectancy of someone with fibromuscular dysplasia? With a dissection, blood gets trapped between the intima and media. 2014;23(2):33542. However, vertebral artery dissection is a common cause of stroke in young and middle-aged adults. Gttingen: Hogrefe Verlag; 2000. 2014;76(9):6707. WebThe vertebral arteries are part of the circulatory system. 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. 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]. For only 2 % of stroke mimics, they were no predictors of and. Trigger events correspondence to Cervical artery dissection: trauma and other situations that in particular include unpredictability uncontrollability! Forms in one of the stress concept and impair Quality of life ; mRS modified Rankin Scale with pain... 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