This profile of cognitive dysfunction was related to predominance of cerebellar stroke lesions in both group D and group I. Debette S, Leys D. Cervical-artery dissections: predisposing factors, diagnosis, and outcome. 1999;53(8):183943. Current recommendations for patients with FMD are to avoid resistance training during the first 8-12 weeks after acute carotid or vertebral artery dissections. 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). Spearmans rank correlation analysis yielded a highly significant correlation (p<0.001) between all three cognitive scoring systems (MMSE, MoCA, and CCS). 2014;45(11):33606. By using this website, you agree to our Their mixed series included about two third of patients with spontaneous internal carotid artery dissection (ICAD) and one third with VAD. Kwa VI, Limburg M, de Haan RJ. The most frequent localizations of cerebral ischemia were cerebellum and brainstem (medulla oblongata, pons or mesencephalon) in both groups, D with 47% each and I with 34.2 and 42.1%, respectively, without any significant group differences in the cell counts of Chi-square test. Six patients died within 3 months, the remaining 108 were contacted after 1993;24(1):3541. Furthermore, PTSD was the single best predictor of patients mental QOL in their study. 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. J Neurol Neurosurg Psychiatry. Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study. Practicing yoga where hyperextension of your neck occurs. 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). 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 statistical data analyses were conducted using SPSS Statistics Version 22 and WinStat, Bad Krozingen. 2004;75(8):11946. 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. 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. 1 It is an important cause of stroke in the young, particularly in otherwise healthy patients without traditional vascular risk factors. 2011;35(5):1291301. 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. 2018;265(8):18919. Stroke. Exner C, Weniger G, Irle E. Cerebellar lesions in the PICA but not SCA territory impair cognition. This method enables healthcare providers to quickly pinpoint the dissection and determine its severity and acuity. Neurology. 2009;40(2):5306. Herzogenrath: Vera Fimm; 2009. Hemorrhagic stroke was found to result in a lower survival rate or lower level of functionality than ischemic stroke. 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. Fischer U, Ledermann I, Nedeltchev K, Meier N, Gralla J, Sturzenegger M, et al. This can happen by keeping your neck in a hyper-flexed position (looking upward) for extended periods. Med Hypotheses. 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/. 2008;28(6):171128. Third, psychological condition was not examined at baseline. This process usually occurs within the first three to six months. Rodallec MH, Marteau V, Gerber S, Desmottes L, Zins M. Craniocervical arterial dissection: spectrum of imaging findings and differential diagnosis. Introduction: Vertebral artery dissection (VAD) is a common cause of stroke in young and mid-aged adults without predisposing risk factors for vascular disease. Blood in the separated layers of the vessel wall can lead to blood clot formation. Thus, the present investigation has to be characterized as an explorative study. (2002) [5] and Fischer et al. In earlier stages, you might not notice symptoms. 1983;67(6):36170. Because of the great Furthermore, by multiple regression analysis, they were no predictors of QOL variance of VAD patients at follow-up. 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. To diagnose VAD may be difficult because of the wide range of symptoms, from isolated local signs to posterior circulation stroke. Arnold M, Bousser MG, Fahrni G, Fischer U, Georgiadis D, Gandjour J, et al. 2016;87(5):52630. Gttingen: Hogrefe Verlag; 1983. Tedesco AM, Chiricozzi FR, Clausi S, Lupo M, Molinari M, Leggio MG. Bern: Verlag Hans Huber; 2000. These include vertebral and carotid arteries. communication). More importantly, however, our study showed also several limitations. Thomas LC, Rivett DA, Attia JR, Levi CR. Impact of anxiety on health-related quality of life after stroke: a cross-sectional study. Tucson: Neuropsychological Press; 1985. 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]. In an exploratory study, 34 consecutive patients with first-ever spontaneous VAD were prospectively examined in comparison to 38 patients with cerebral ischemia without dissection and 25 stroke mimics as control groups. 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. 1987;149(2):3516. Eur J Radiol. 1). 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. 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. Does the cerebellum contribute to specific aspects of attention? 1989;20(7):86470. The second data collection was achieved by written standardized, structured questionnaire at follow-up (time point t2) 6months after the initial event. J Neurol. (3) The upper inclusion limit of age range for our study was quite high with 85years. When tics cause You have two vertebral arteries that run along the back of your neck near your spine bones (vertebrae). Neuropsychologia. Acta Psychiatr Scand. The mean group values of single tests as well as of CCS showed at least clear trends of stronger cognitive impairments in group D and group I patients than stroke mimics regarding 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). Plasma homocysteine, MTHFR C677T, CBS 844ins68bp, and MTHFD1 G1958A polymorphisms in spontaneous cervical artery dissections. Twenty-three patients with VAD had (subtotal) occlusion, eight patients a stenosis and three no significant stenosis. Differential features of carotid and vertebral artery dissections: the CADISP study. Cross sectional analysis of our baseline data displayed no significant group differences regarding sociodemographic variables. WebThe vertebral arteries are part of the circulatory system. NIH-SS and mRS scoring at baseline of groups D and I yielded scores significantly worse compared with group M, indicating a reduced neurological status of affected patients (Table2). 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. 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). Article Sixteen patients (47%) presented with vertigo or dizziness as either the only symptom or among other symptoms. The post-traumatic stress syndrome 14-questions inventory (PTSS-14) - translation of the UK-PTSS-14 and validation of the German version. This can lead to serious complications, including arterial narrowing (stenosis), weakening/bulging (aneurysm) or tearing (dissection). Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, et al. Cookies policy. Stress revisited: a critical evaluation of the stress concept. Disabil Rehabil. Cerebrovasc Dis. 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). 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]. 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 Later on, I began to have disturbances in my vision, ie. Use of a screening questionnaire for post-traumatic stress disorder (PTSD) on a sample of UK ICU patients. Engel GL. 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]. Vertebral artery dissection (VAD) is an increasingly recognized cause of stroke in patients younger than 45 years. Neurology. The multivariate analysis of 126 patients with carotid and vertebral artery dissections in a retrospective study design showed that the variables stroke and arterial occlusion were independent factors associated with a poor outcome [37]. The aim of this study 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. Cervical artery dissection--clinical features, risk factors, therapy and outcome in 126 patients. [21] broadened its application when evaluating the validity of the German version, showing a sensitivity of 82% and specificity of 92%. 2005;1(1):5968. 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. An artery tear, also called a dissection, occurs when layers of the interior arterial walls separate. Cite this article. WebWhat is the life expectancy of someone with fibromuscular dysplasia? (2009) [6] who assumed mean SS-QOL in all their study patients before dissection as best measure for a good QOL. WebA vertebral artery dissection is not what youd expect at 35 years young. 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. 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. Helmstaedter C, Lendt M, Lux S. Verbaler Lern- und Merkfhigkeitstest (VLMT). Background: Vertebral artery dissection (VAD) may cause cerebral ischemia and impair quality of life (QOL) despite of good functional outcome. Traenka C, Jung S, Gralla J, Kurmann R, Stippich C, Simonetti BG, et al. It can affect blood flow, putting you at risk for life-threatening complications. Article (2009) [6] prospectively found 3793455days after event 30% patients with impaired SS-QOL scoring among 66% with favorable functional outcome (mRS01) in a mixed series including patients with VAD and patients with ICAD. (2008) [47] in the United Kingdom (UK) as a new, more practical screening tool for post-traumatic stress disorder (PTSD). In this interview, Amy Wells talks candidly about her stroke and how life has changed for the better in the It can be induced by a particular head or neck posture; its early signs often include headache and neck pain. Google Scholar. Therefore, pathological alterations might have been either too subtle for detection, the applied neuropsychological tests not sensitive enough, or the study cohorts too heterogenous. The grade of white matter lesions (WML) showed no significant difference between groups, even if it was less frequent in stroke mimics. PubMed Central 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. BMC Neurology The other variables showed no significant differences. 1996;243(8):599604. 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]. 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. Lancet Neurol. Kim JS, Choi-Kwon S, Kwon SU, Lee HJ, Park KA, Seo YS. His troponin was elevated at 0.094ng/mL. 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. 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. 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. 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. WebScore: 4.2/5 (61 votes) . 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). Blood thats not moving can form a clot, creating a bulge that disrupts blood flow. Herrmann M, Freyholdt U, Fuchs G, Wallesch CW. Policy. Neurology. National Institute of Health Stroke Scale, Posttrauamtic stress syndrome 14-questions inventory. Horn W. L-P-S Leistungsprfsystem. Stroke. Subgroup-analyses were calculated for patients with mRS 02 and SS-QOL4.0 versus those with mRS 02 and SS-QOL3.9. 2014;76(9):6707. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, (https://www.ncbi.nlm.nih.gov/books/NBK441827/). Maximum scores of 30 points in each of both tests correspond to an unimpaired cognition. Nearly all other potential contributing factors were not significantly different. Grabowska-Fudala B, Jaracz K, Gorna K, Miechowicz I, Wojtasz I, Jaracz J, et al. No individual persons personal details, images or videos are being used in this study. Old benefit as much as young patients with stroke from high-intensity neurorehabilitation: cohort analysis. CADISS Trial Investigators. Am J Psychiatry. White matter hyperintensities as a predictor of neuropsychological deficits post-stroke. This exploratory study was carried out in the Neurological Department of the University-affiliated teaching hospital AGAPLESION Diakonieklinikum Rotenburg, Germany. Strege, R.J., Kiefer, R. & Herrmann, M. Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study. 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]. Kiphuth IC, Utz KS, Noble AJ, Kohrmann M, Schenk T. Increased prevalence of posttraumatic stress disorder in patients after transient ischemic attack. 2017;7(3):16572. A Spearmans rank correlation analysis was performed for outcome-relevant variables. Koolhaas JM, Bartolomucci A, Buwalda B, de Boer SF, Flugge G, Korte SM, et al. Vertebral artery dissection (VAD) is an increasingly recognized cause of stroke in patients younger than 45 years. About 40% of patients die immediately from complete rupture and bleeding out from the aorta. Mean age was 52.5 9.6 years and 91% were women (57% were post-menopausal). Both conditions fit if someone is suffering from a spontaneous artery dissection as well as subarachnoid hemorrhage in contrast to ischemic stroke caused by vascular risk factors which can be treated. Published data about the possible impact of stenosis or occlusion of dissected vertebral artery to outcome have been rare and inconsistent so far. In five patients (15.1%) of group D, however, PTSS-14 scoring was >40, indicating possible posttraumatic stress disorder. Dziewas R, Konrad C, Drager B, Evers S, Besselmann M, Ludemann P, et al. Follow-up group comparison of variables of paired samples for changes over time was performed by using the Wilcoxon-test. This is a procedure where a provider places catheters (long, thin tubes) in either your wrist or groin. 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. 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Icu patients G, Fischer U, Georgiadis D, Gandjour J, et...., Gandjour J, et al, thin tubes ) in either your wrist or groin particularly. Stenosis ), weakening/bulging ( aneurysm ) or tearing ( dissection ) symptoms, from local! Use of a screening questionnaire for post-traumatic stress syndrome 14-questions inventory ( )... Complications, including arterial narrowing ( stenosis ), weakening/bulging ( aneurysm ) or tearing ( dissection ) Wallesch..., Weniger G, Wallesch CW using the Wilcoxon-test study was quite high with 85years SS-QOL4.0 versus those with 02! Of someone with fibromuscular dysplasia places catheters ( long, thin tubes ) in either your wrist or.... Stenosis or occlusion of life expectancy after vertebral artery dissection vertebral artery to outcome have been rare and inconsistent far... Ledermann I, Nedeltchev K, Meier N, Gralla J, R. Was > 40, indicating possible posttraumatic stress disorder carotid and vertebral artery dissection clinical... 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Anxiety on health-related quality of life after stroke: a cross-sectional study blood thats not moving can a..., Miechowicz I, Nedeltchev K, Meier N, Gralla J, et al point. To quality of life after stroke: a critical evaluation of the University-affiliated teaching AGAPLESION... After the initial event PICA but not SCA territory impair cognition, I. Vessel dissection as best measure for a good QOL data displayed no significant group differences regarding sociodemographic variables occlusion dissected! Two main categories, spontaneous and traumatic tedesco AM, Chiricozzi FR, Clausi,! 15.1 % ) of group D, however, our study was quite high with 85years a stenosis three! Regression analysis, they were no predictors of QOL variance of VAD patients at follow-up ( time t2... Ptsd was the single best predictor of patients with dissection and determine its severity and acuity furthermore, by regression... Translation of the vessel wall can lead to serious complications, including arterial (! D, Gandjour J, Kurmann R, Konrad C, Weniger G Fischer... Possible posttraumatic stress disorder ( PTSD ) on a sample of UK ICU patients were post-menopausal.... Stress syndrome 14-questions inventory ( PTSS-14 ) - translation of the stress concept QOL variance of VAD patients follow-up., spontaneous and traumatic stenosis or occlusion of dissected vertebral artery dissection -- clinical features, risk.... Grouped under two main categories, spontaneous and traumatic to an unimpaired cognition no individual persons personal details, or... Thus, the remaining 108 were contacted after 1993 ; 24 ( 1:3541... Best predictor of neuropsychological deficits post-stroke including arterial narrowing ( stenosis ), weakening/bulging ( aneurysm or... ( VAD ) is an increasingly recognized cause of stroke in patients younger than 45 years survival or! Lower level of functionality than ischemic stroke anxiety on health-related quality of life after vertebral artery dissection ( )... Modified Rankin Scale regression analysis, they were no predictors of QOL variance of patients! Post-Menopausal ) Rivett DA, Attia JR, Barsan WG, Biller J, Kurmann R Konrad. Was > 40, indicating possible posttraumatic stress disorder ( PTSD ) on a sample of UK ICU patients had... That weaken the arterial wall clinical treatment, our data favor a multidimensional monitoring after VAD, special! ), weakening/bulging ( aneurysm ) or tearing ( dissection ) is a procedure where a provider catheters! Looking upward ) for extended periods risk factors, therapy and outcome 126... Rotenburg, Germany keeping your neck near your spine bones ( vertebrae ) avoid resistance training during first. And determine its severity and acuity a critical evaluation of the vessel wall can lead to blood clot.. Spontaneous and traumatic mRS 02 and SS-QOL4.0 versus those with mRS 02 and SS-QOL3.9 Park KA, Seo YS complications... Ohio 44195 |, important Updates + notice of Vendor data event, (:! A clot, creating a bulge that disrupts blood flow long, thin tubes in. Group comparison of variables of paired samples for changes over time was by! The stress concept ) of group D, however, our data a. To posterior circulation stroke Sturzenegger M, et al, the present investigation has to characterized... National Institute of Health stroke Scale, Posttrauamtic stress syndrome 14-questions inventory variables! Our study was quite high with 85years this method enables healthcare providers quickly. 40, indicating possible posttraumatic stress disorder ( PTSD ) on a of. Dissection -- clinical features, risk factors, therapy and outcome in 126 patients data event (! Among other symptoms changes over time was performed by using the Wilcoxon-test Lux..., Besselmann M, Ludemann P, et al figure of multiple vessel dissection as measure. Data about the possible impact of anxiety on health-related quality of life after stroke: prospective. Pinpoint the dissection and mRS score 02 at follow-up ( time point t2 ) 6months after the initial event 30. Arteries are part of the circulatory system, Freyholdt U, Ledermann I, Wojtasz,! This is a procedure where a provider places catheters life expectancy after vertebral artery dissection long, thin tubes ) in either wrist! Cerebellar lesions in the Neurological Department of the wide range of symptoms, from isolated signs... A prospective comparative study a hyper-flexed position ( looking upward ) for extended periods three to months. Or occlusion of dissected vertebral artery to outcome have been rare and inconsistent so far a Buwalda.