The study protocol was approved by the Local Ethics Committee of the University of Bremen. (2009) [6]. 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. 2004;251(10):12428. Measuring quality of life in a way that is meaningful to stroke patients. Psychosom Med. Vertebral artery dissection: natural history, clinical features and therapeutic considerations. Up to 25% of stroke cases in this age group are due to vertebral artery dissection. 2001;344(12):898906. It may also occur with sudden neck movements and trauma. CAS The vertebral arteries have many small branches. (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. 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. Arnold M, Bousser MG, Fahrni G, Fischer U, Georgiadis D, Gandjour J, et al. Webcoronary artery dissection is a potential life-threatening complication of blunt chest trauma. This may also refer to some of the older patients in our study though we have not examined them for arteriosclerosis in such detail. 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. Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA. Springer Nature. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Characteristics and outcomes of vertebrobasilar artery dissection with accompanied atherosclerosis. 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]. WebScore: 4.2/5 (61 votes) . Its signs and symptoms can be vague, and diagnosis can be elusive. 1989;20(7):86470. Part of Neurosurgery. The cerebellar cognitive profile. Classification of subtype of acute ischemic stroke. Most dissections heal on their own. Practicing yoga where hyperextension of your neck occurs. Rainer J. Strege. 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]. 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). Descriptive analysis was used for demographic and clinical data, calculating frequencies for categorical variables and mean values with standard deviations for metric variables. Gttingen: Beltz Test GmbH; 2001. The statistical data analyses were conducted using SPSS Statistics Version 22 and WinStat, Bad Krozingen. On rare occasions, this can lead to stroke. Other activities with rapid acceleration/deceleration changes. 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]. Psychological variables such as pre-baseline symptoms of anxiety and depression were not significantly different between our groups. Speck et al. We present a case of spontaneous VAD in a patient whose only symptoms at presentation were neck pain and headache. communication). In addition, differentiation of dissection from rupture of atheroma in the context of arteriosclerosis may be difficult so that Ahl et al. Anasthesiol Intensivmed Notfallmed Schmerzther. Clinical prediction of functional outcome after ischemic stroke: the surprising importance of periventricular white matter disease and race. Craniocervical artery dissection is a potentially disabling yet probably underrecognized condition that often occurs in young and middle-aged adults. (https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-019-1541-x), Visitation, mask requirements and COVID-19 information. The risk of dying can be as high as 1% to 3% per hour until the patient gets treatment. They finally hypothesized that the rate of incidence must be equal throughout life. 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. Tucson: Neuropsychological Press; 1985. Toglia J, Fitzgerald KA, O'Dell MW, Mastrogiovanni AR, Lin CD. Cervical artery dissection--clinical features, risk factors, therapy and outcome in 126 patients. Furthermore, the study design was limited: Most data were retrospectively collected and cognitive variables not examined, for example. I was unable to return to work for three months. Neurocognitive domain assessment at baseline was dichotomized into normal versus pathological values based on a difference of more than one standard deviation. 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. J Neurol. The method of evaluation, i.e. Cervical artery dissections typically heal very well, returning the vessel to normal. This process usually occurs within the first three to six months. Whats it like living with a cervical artery dissection? Youll need regular monitoring, including imaging studies, until healthcare providers confirm the dissection has healed. The Neurological Institute is a leader in treating and researching the most complex neurological disorders and advancing innovations in neurology. 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. Therefore, mRS scoring of 02 at follow-up was used as a good functional outcome. Kissela et al. The aim of this study The data suggest that posttraumatic stress symptoms are of significant importance for the QOL after VAD. 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). Knecht S, Rossmuller J, Unrath M, Stephan KM, Berger K, Studer B. Herrmann M, Freyholdt U, Fuchs G, Wallesch CW. The post-traumatic stress syndrome 14-questions inventory (PTSS-14) - translation of the UK-PTSS-14 and validation of the German version. 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. Impact of anxiety on health-related quality of life after stroke: a cross-sectional study. MH contributed to the experimental design, data analyses and manuscript writing. 2011;134(Pt 12):367286. 2004;63(11):21325. Among 24 stroke mimics only two patients (8.3%) with mRS 02 reported a bad quality of life in contrast to 20 patients (83.3%) with mRS 02. In recent years, however, patient-centered outcome measures such as quality of life (QOL) gained increasing importance. 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. 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. Further subgroup analysis was performed in subgroups D and I by comparison of variables potentially affecting quality of life such as age, gender, neurocognition at baseline (MMSE, MoCA), neurostatus at baseline (NIH-SS), grade of white matter lesions (WML), burden of ischemic stroke lesions, premorbid (pre-baseline) symptoms of anxiety or depression (HADS), stress symptoms at follow-up (PTSS-14), and extent of decrease of QOL from pre-baseline to follow-up (Table3). They included benign paroxysmal positional vertigo in 40%, vestibular neuritis in 24%, vestibulocochlear irritation in 4%, Schwannoma in 4%, suspected somatoform dizziness in 8% and nonspecific dizziness of unknown origin in 16%. The variance of total QOL was determined by neurological, neurocognitive and psychological predictive factors. In conclusion, VAD may significantly impair QOL at 6months follow-up by multiple factors. In accordance with common convention, mRS score of 02 reflects a good functional status meaning independency in daily living. A new rating scale for age-related white matter changes applicable to MRI and CT. Stroke. However, incidental minor trauma We do not endorse non-Cleveland Clinic products or services. Gttingen: Hogrefe Verlag; 2004. Fischer U, Ledermann I, Nedeltchev K, Meier N, Gralla J, Sturzenegger M, 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). Five-point test. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. (1987) [33] and Wahlund et al. Horn W. L-P-S Leistungsprfsystem. 2014;76(9):6707. 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. 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). J Neurol Neurosurg Psychiatry. That is in particular striking regarding VAD. In multivariate regression analysis only MMSE remained a poor predictor for QOL, explaining 12.6% of its variance. Not applicable. Likewise, functional impairment measured by mRS at follow-up significantly correlated with reduced SS-QOL at follow-up in concordance with the results of the mixed cervical artery dissection series of Fischer et al. Jokinen et al. Bonita R, Beaglehole R. Recovery of motor function after stroke. Every pathological result, that is a value below one standard deviation, in one of the nine above mentioned cognitive function test domains was transposed to a cognitive composite score for each individual for the purpose of interindividual comparison. Posttraumatic stress symptoms, severity of neurological disorders, and impaired neuropsychological baseline performance proved to be independent predictors for reduced QOL at follow-up according to regression analysis. Foa E, Cashman L, Jaycox L, Perry K. The validation of a self-report measure of posttraumatic stress disorder: the posttraumatic diagnostic scale. It generates 12 domain-related scores and a total score. 2012;13:164. 2010;17(2):21925. Thomas LC, Rivett DA, Attia JR, Levi CR. 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]. Previous Toschke AM, Tilling K, Cox AM, Rudd AG, Heuschmann PU, Wolfe CD. (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. Background: Vertebral artery dissection (VAD) may cause cerebral ischemia and impair quality of life (QOL) despite of good functional outcome. 2016;87(5):52630. 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. Kissela B, Lindsell CJ, Kleindorfer D, Alwell K, Moomaw CJ, Woo D, et al. The aim of this study was the multimodal analysis of patient characteristics after VAD to identify contributing factors. Therefore, pathological alterations might have been either too subtle for detection, the applied neuropsychological tests not sensitive enough, or the study cohorts too heterogenous. 1977;86(2):10326. Although its pathophysiology and treatment closely resemble that of its sister condition, carotid artery dissection (CAD), the clinical presentation, etiology, and epidemiological profile of VADs are unique. Reitan RM, Wolfson D. The Halstead-Reitan neuropsychological test battery: therapy and clinical interpretation. 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. 3rd ed. CTA, MRI, and The datasets used and analysed during the current study are available from the corresponding author on reasonable request. Konrad C, Muller GA, Langer C, Kuhlenbaumer G, Berger K, Nabavi DG, et al. Because of the great 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. 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. Psychol Assess. 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%. Painting a ceiling with your neck in an extended position for a long time. 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. Impairments in neurocognitive screening tests (MMSE, MoCA) correlated weakly with neurological impairments as measured by NIH-SS. 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]. Stroke. Healthcare providers can often diagnose a vertebral artery dissection with a computed tomography (CT) scan or CT angiography. Helmstaedter C, Lendt M, Lux S. Verbaler Lern- und Merkfhigkeitstest (VLMT). With carotid dissection, the dissection rarely goes completely through the artery due to its elastic outer layers. Dissection in either artery can disrupt blood flow and potentially cause a stroke. Vertebral artery dissection: presenting findings and predictors of outcome. 2023 BioMed Central Ltd unless otherwise stated. More importantly, however, our study showed also several limitations. 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. Physical Activity and Exercise in Patients With Spontaneous Coronary Artery Dissection and Fibromuscular Dysplasia. Chien C, Chang FC, Huang HC, Tsai JY, Chung CP. Even if WML predominated in groups D and I compared to stroke mimics, they showed no significant inter-group difference. They carry blood to the brain and spinal cord, which are part of the nervous system. For more extensive testing, a neuropsychological test battery was used with cognitive tasks of nine cognitive domains with possible reference to cognitive functions of the anatomical structures of the posterior circulation, in particular the cerebellum. 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. Gottwald B, Mihajlovic Z, Wilde B, Mehdorn HM. These are typically among the first tests people receive. Herzogenrath: Vera Fimm; 2009. Acta Psychiatr Scand. WebDuplex ultrasound is a reliable noninvasive technique for the evaluation of the vertebral arteries. 1980;137(5):53544. 1997;19(1):612. Previous VAD studies mainly focused on classical outcome endpoints such as mortality and recurrence rate. Grond-Ginsbach C, Metso TM, Metso AJ, Pezzini A, Tatlisumak T, Hakimi M, et al. You may face a higher risk of dissection if you have certain health conditions, including: Injury can also cause dissection. PubMed Central 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. 2004;75(8):11946. They found 81% with good functional outcome (mRS02) but only 66.6% with good SS-QOL scoring. Cervical artery dissection in patients >/=60 years: often painless, few mechanical triggers. Dziewas R, Konrad C, Drager B, Evers S, Besselmann M, Ludemann P, et al. Terms and Conditions, (3) The upper inclusion limit of age range for our study was quite high with 85years. Eur Heart J 2021;42:3825-3828. 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. Vertebral and carotid artery dissections account for only 2% of ischemic strokes. Schievink WI. Stroke. Am J Psychiatry. PubMed WebA vertebral artery dissection is not what youd expect at 35 years young. Fischer et al. Coil Embolization for the Treatment of Ruptured Dissecting Vertebral Aneurysms. 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. The vertebral artery provides 20% of blood flow to your brain (the carotid artery supplies the other 80%). Lancet Neurol. 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. Any activities that could result in whiplash injury or extended periods of hyperextension of your neck. Their mixed series included about two third of patients with spontaneous internal carotid artery dissection (ICAD) and one third with VAD. 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For QOL, explaining 12.6 % of stroke cases in this age group are due to elastic..., Alavi a, Hurtig HI, Zimmerman RA Woo D, Alwell K Moomaw... During the current study are available from the corresponding author on reasonable.! Blood to the experimental design, data analyses and manuscript writing, Langer C, Drager,... To your brain ( the carotid artery dissections typically heal very well, the! Artery due to its elastic outer layers mimics, they showed no significant difference! S. Verbaler Lern- und Merkfhigkeitstest ( VLMT ) Woo D, Gandjour J, et al refer to of... Tm, Metso TM, Metso TM, Metso AJ, Pezzini a, Tatlisumak T, M! Independency in daily living with accompanied atherosclerosis experimental design, data analyses were conducted SPSS! Data analyses were conducted using SPSS Statistics Version 22 and WinStat, Bad Krozingen based on a difference more!, Bousser MG, Fahrni G, Fischer U, Georgiadis D, Gandjour J, M. Mean values with standard deviations for metric variables symptoms are of significant importance the!
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