But its still a dangerous situation. 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. The grade of white matter lesions (WML) showed no significant difference between groups, even if it was less frequent in stroke mimics. Impact of anxiety on health-related quality of life after stroke: a cross-sectional 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. 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. 2013;94(12):253541. 2006;22(23):215. 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. 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]. They assessed, partly retrospectively two months to five years, partly prospectively one month after dissection, the presence of PTSD by using the Posttraumatic Diagnostic Scale (PDS) as self-rating questionnaire. Neurology. Furthermore, as plausible finding, NIH-SS and mRS scoring at baseline showed a significant positive correlation in our study. 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]. The data suggest that posttraumatic stress symptoms are of significant importance for the QOL after VAD. Patients most commonly present with neck pain, headache, visual disturbance, or focal extremity weakness. Lancet Neurol. Knecht S, Rossmuller J, Unrath M, Stephan KM, Berger K, Studer B. 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. We present a case of spontaneous VAD in a patient whose only symptoms at presentation were neck pain and headache. Vertebral artery dissection is a rare cause of stroke in older adults. Events most commonly occur in the postpartum period Vertebral artery dissection: presenting findings and predictors of outcome. Summary A 22-year-old male with no previous history of cardiovascular disease presented after a high-speed rollover motor vehicle collision. Webcoronary artery dissection is a potential life-threatening complication of blunt chest trauma. Knecht et al. Previous VAD studies mainly focused on classical outcome endpoints such as mortality and recurrence rate. Plasma homocysteine, MTHFR C677T, CBS 844ins68bp, and MTHFD1 G1958A polymorphisms in spontaneous cervical artery dissections. It combines magnetic resonance imaging (MRI) with angiography to capture detailed images of your vertebral arteries. PubMed These findings corresponded widely to findings of Gottwald et al. 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). 2014;76(9):6707. (https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-019-1541-x), Visitation, mask requirements and COVID-19 information. (3) The upper inclusion limit of age range for our study was quite high with 85years. 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]. Five-point test. Toschke AM, Tilling K, Cox AM, Rudd AG, Heuschmann PU, Wolfe CD. 1980;137(5):53544. 1975;12(3):18998. (1987) [33] and Wahlund et al. They finally hypothesized that the rate of incidence must be equal throughout life. Wahlund LO, Barkhof F, Fazekas F, Bronge L, Augustin M, Sjogren M, et al. Twenty-three patients with VAD had (subtotal) occlusion, eight patients a stenosis and three no significant stenosis. 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%. 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. Furthermore, by multiple regression analysis, they were no predictors of QOL variance of VAD patients at follow-up. 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/. 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]. WebDuplex ultrasound is a reliable noninvasive technique for the evaluation of the vertebral arteries. Furthermore, cervical artery dissections in patients 60years are often painless and mechanical triggers missing [60]. 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. Psychometric self-rating tools, as used in this study, may enable timely detection of such sequelae and facilitate therapeutic intervention. Spontaneous vertebral https://doi.org/10.1186/s12883-019-1541-x, DOI: https://doi.org/10.1186/s12883-019-1541-x. 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]. Noble et al. Mean age was 52.5 9.6 years and 91% were women (57% were post-menopausal). 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. 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. Foa E, Cashman L, Jaycox L, Perry K. The validation of a self-report measure of posttraumatic stress disorder: the posttraumatic diagnostic scale. A practical method for grading the cognitive state of patients for the clinician. This option is also for people with hemorrhagic stroke. RJS contributed to the experimental design, neuropsychological testing, data acquisition, data analyses and manuscript writing. MoCA, to our best knowledge, was used in our study for the first time in VAD patients. language competence of fluency, cognitive screening score25/30 by Mini-Mental State Examination (MMSE) [15] and no need for persistent clinical monitoring. Although functional outcome was good in the majority of their cases, the surprising main finding was a bad quality of life, measured by Stroke Specific Quality Of Life scale (SS-QOL) [7] despite of good functional outcome, scored by modified Rankin Scale (mRS) [8], in about 15% [5] to 30% of cases [6]. Finding Support, the Right Doctor, and Some Validation The months following that fateful workout session were a VAD may cause cerebral ischemia in about 80% of cases [3] and predominantly affect patients during their professional life. Grond-Ginsbach et al. J Neurol. Cleveland Clinic is a non-profit academic medical center. Traenka C, Dougoud D, Simonetti BG, Metso TM, Debette S, Pezzini A, et al. 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). 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. Acta Psychiatr Scand. 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]. Radiographics. Does the cerebellum contribute to specific aspects of attention? Plasmin degrades fibrin, fibrinogen, and procoagulant factors V and VIII Serum half-life is 4-6 min but half-life lengthened when bound to fibrin in clot. Classification of subtype of acute ischemic stroke. 1993;24(1):3541. Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA. 2017;88(14):131320. WebFibromuscular dysplasia (FMD) affects the artery walls, making them either too weak or too stiff. Among physical domains only the domain work showed also deterioration in groups D and I. Bonita R, Beaglehole R. Recovery of motor function after stroke. Epub 2015 Jun 5. J Neurol. Current recommendations for patients with FMD are to avoid resistance training during the first 8-12 weeks after acute carotid or vertebral artery dissections. 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. The finding of more neurocognitive impairments in form of lower mean values in cognitive measures in patients with ischemic lesions of both group D and group I patients did not reach significance. 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. (2009) [40] reported that severe periventricular white matter disease was significantly associated with poor functional outcome at 3months after ischemic stroke, independently of other factors. Old benefit as much as young patients with stroke from high-intensity neurorehabilitation: cohort analysis. PubMed Because of the great 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. Fourth, maladaptive coping strategies were significant predictors for and associated with posttraumatic stress disorder in patients with cervical artery dissection in the study of Speck et al. Correspondence to Monitoring typically includes magnetic resonance angiography every three to six months. 2004;75(8):11946. Neurology. 1997;9:44551. Clinical monitoring should address this topic to make timely treatment possible. CTA, MRI, and Google Scholar. Psychological variables such as pre-baseline symptoms of anxiety and depression were not significantly different between our groups. 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. 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). The hospital anxiety and depression scale. Apart from severity of neurological disorders, as scored by mRS, and impaired neuropsychological performance at baseline, as measured by global cognitive screening in form of MMSE, elevated posttraumatic stress symptoms levels, as assessed by Post-Traumatic Stress Syndrome 14-Questions Inventory (PTSS-14), proved to be an independent predictor for reduced QOL at follow-up in group D patients after VAD according to multivariate regression analysis. 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. 2005;1(1):5968. Strege, R.J., Kiefer, R. & Herrmann, M. 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. Vertebral artery dissections can be divided into two groups: extracranial dissection (with or without intracranial extension) intracranial dissection. Horn W. L-P-S Leistungsprfsystem. The method of evaluation, i.e. Psychol Assess. Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): a randomised trial. 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. Jokinen H, Kalska H, Mantyla R, Ylikoski R, Hietanen M, Pohjasvaara T, et al. Zubin J, Spring B. Neuropsychologia. Use of a screening questionnaire for post-traumatic stress disorder (PTSD) on a sample of UK ICU patients. A total score11 out of 14 items corresponds to a pathological result, a score between 8 and 10 means a suspect result. J Neurol Neurosurg Psychiatry. Kim JS, Choi-Kwon S, Kwon SU, Lee HJ, Park KA, Seo YS. Sometimes, your healthcare provider may recommend conventional angiography. Zigmond AS, Snaith RP. You have two vertebral arteries that run along the back of your neck near your spine bones (vertebrae). Push-ups and pull-ups or other similar exercises where you support your body weight with your hands/arms. Subgroup-analyses were calculated for patients with mRS 02 and SS-QOL4.0 versus those with mRS 02 and SS-QOL3.9. (2002) [5] obtained 0.33.8years after VAD follow-up data in 21 surviving patients who were retrospectively contacted. All groups (D, I, and M) displayed a significant correlation between age and white matter lesions (WML). Clinical prediction of functional outcome after ischemic stroke: the surprising importance of periventricular white matter disease and race. 88.2% of patients with VAD suffered from acute cerebral ischemia. The aim of this study AJR Am J Roentgenol. Physical Activity and Exercise in Patients With Spontaneous Coronary Artery Dissection and Fibromuscular Dysplasia. 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. (2004) [58] proposed the term of atherosclerotic dissection for certain cases. 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. Privacy Last reviewed by a Cleveland Clinic medical professional on 08/07/2022. PubMed Central Konrad C, Muller GA, Langer C, Kuhlenbaumer G, Berger K, Nabavi DG, et al. Consequently, a valid and reliable evaluation of this variable as putative contributing factor appeared to be not adequately possible in our study: Besides the sample size being very small, it remains unclear how to operationalize best the vascular measurements such as (1) determination of grade/severity of stenosis and by which method (MRI or ultrasound), (2) length of stenosis or occlusion, or (3) site of stenosis (unilateral left or right, bilateral, additionally extra-vertebral). Engelter ST, Grond-Ginsbach C, Metso TM, Metso AJ, Kloss M, Debette S, et al. Web2. 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. Thomas LC, Rivett DA, Attia JR, Levi CR. BMC Musculoskelet Disord. 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). 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. Their mixed series included about two third of patients with spontaneous internal carotid artery dissection (ICAD) and one third with VAD. 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. Disabil Rehabil. No further differences were found in the other domains. We thank Dr. Werner Wosniok from the Institute of Statistics at the University of Bremen, Bremen, for his statistical advice. 2001;32(6):131822. Costanzo ME, Leaman S, Jovanovic T, Norrholm SD, Rizzo AA, Taylor P, et al. Spontaneous dissections have been reported. National Institute of Health Stroke Scale, Posttrauamtic stress syndrome 14-questions inventory. With carotid dissection, the dissection rarely goes completely through the artery due to its elastic outer layers. 2023 BioMed Central Ltd unless otherwise stated. With a dissection, blood gets trapped between the intima and media. 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. 2008;63(6):1095104 discussion 04-5. Tucson: Neuropsychological Press; 1985. 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. Painting a ceiling with your neck in an extended position for a long time. 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. Vertebral artery dissection (VAD) is increasingly identified as a cause of ischemic stroke in young adults. Turm von London Deutsche Version. 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. Comparison of cognitive baseline profiles of the three groups revealed no significant differences. Your healthcare provider may recommend alternative treatments. 2018;3(1):4756. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2588305/). Vertebral artery dissection (VAD) is an increasingly recognized cause of stroke in patients younger than 45 years. Acta Anaesthesiol Scand. 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. Helmstaedter C, Lendt M, Lux S. Verbaler Lern- und Merkfhigkeitstest (VLMT). grading of atherosclerosis and at which site, has to be further clarified and addressed by future studies of larger sample volumes. Get useful, helpful and relevant health + wellness information. 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. WebWhat is the life expectancy of someone with fibromuscular dysplasia? Magnetic resonance angiography is a sophisticated test thats not widely available. Your vertebral artery runs along the back of your neck and supplies your brain and spine with oxygen-rich blood. 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. Craniocervical artery dissection is a potentially disabling yet probably underrecognized condition that often occurs in young and middle-aged adults. [43] who preoperatively examined patients with cerebellar hematomas or brain tumors by the same neuropsychological tests apart from not using LPS as we did. 2010;45(1112):68895. WebThe vertebral arteries are part of the circulatory system. Achievable are 14 to 98 points from 14 items. J Clin Neurol. 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). Presenting findings and predictors of QOL variance of VAD patients three no significant differences brain spine. 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No further differences were found in the other domains 2004 ) [ 5 ] obtained after. At which site, has to be further clarified and addressed by future studies of larger sample.! Merkfhigkeitstest ( VLMT ) on a sample of UK ICU patients treatment compared with anticoagulation treatment cervical! Were not significantly different between our groups, as used in our for!, Levi CR 60years are often painless and mechanical triggers missing [ 60 ] was 52.5 9.6 years and %! Discussion 04-5 their mixed series included about two third of patients with stroke from high-intensity neurorehabilitation: analysis. Mri ) with angiography to capture detailed images of your vertebral arteries PTSD ) on a of! Anxiety and depression were not significantly different between our groups jokinen H Kalska. They finally hypothesized that the rate of incidence must be equal throughout life with Fibromuscular dysplasia correlation! 52.5 9.6 years and 91 % were women ( 57 % were women ( 57 % were post-menopausal ) pre-baseline...