Med Hypotheses. 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%). Acta Psychiatr Scand. 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. (2) Broad neuroimaging of cervical arteries including cervical MRA was regularly applied to patients of all age groups and risk profiles whenever differential diagnosis of VAD appeared to be possible. Neurorehabil Neural Repair. All participants were informed about the procedure and gave written informed consent to participate in the 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. 2013;80(6):78790. Cite this article. communication). 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). GA compendium of neuropsychological tests. 1977;86(2):10326. VAD may cause cerebral ischemia in about 80% of cases [3] and predominantly affect patients during their professional life. J Stroke Cerebrovasc Dis. Schievink WI. 1997;19(1):612. Psychosom Med. Group D only displayed a significant lower mean value than groups I and M in the domain social roles. (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. In this interview, Amy Wells talks candidly about her stroke and how life has changed for the better in the 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. Eur J Neurol. The main findings were found in subgroup D (mRS 02) with bad QOL3.9 that were significantly higher mean values for premorbid anxiety symptoms (p=0.006) and stress symptoms at follow-up (p=0.002). 1999;53(8):183943. 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. Plank position (but otherwise safe to participate in yoga or Pilates). Characteristics and outcomes of vertebrobasilar artery dissection with accompanied atherosclerosis. 2007;21(2):1618. Vulnerability--a new view of schizophrenia. Impairments in neurocognitive screening tests (MMSE, MoCA) correlated weakly with neurological impairments as measured by NIH-SS. Secondary exclusion due to defined criteria decreased the number of baseline patients of group D to 34 and group M to 25. Furthermore, some recently published data suggested for the first time a role of VAD-accompanied atherosclerosis as additional putative contributing factor to functional outcome at three months in posterior circulation stroke (PCS) patients [39]. Furthermore, it may sufficiently explain the predominant impairments of psychosocial QOL domains after VAD. The grade of white matter lesions (WML) showed no significant difference between groups, even if it was less frequent in stroke mimics. Cervical artery dissection is commonly considered to be underdiagnosed [3, 57,58,59]. Gttingen: Hogrefe Verlag; 1983. Five patients were excluded from the dissection study group after screening according to the inclusion/exclusion study criteria: One woman (70years old; ataxia, dizziness, facial weakness; medulla oblongata infarction by vertebral artery occlusion suspicious for but not yet proven dissection) deceased due to unexpected cardiopulmonary failure not otherwise specified in the acute phase. Ahl et al. 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. Grond-Ginsbach C, Metso TM, Metso AJ, Pezzini A, Tatlisumak T, Hakimi M, et al. In the most severe cases, vertebral artery dissection causes stroke: In some people, vertebral artery dissection occurs for no known reason. Depressive symptoms in stroke patients treated and non-treated with intravenous thrombolytic therapy: a 1-year follow-up study. Helmstaedter C, Lendt M, Lux S. Verbaler Lern- und Merkfhigkeitstest (VLMT). Stroke. This can happen by keeping your neck in a hyper-flexed position (looking upward) for extended periods. 37 patients fulfilled the inclusion criteria and were included into the study as group D. In addition, 38 patients with acute stroke or TIA of the posterior circulation were included as comparison group I and 27 stroke mimics of the posterior circulation as comparison group M (Fig. The statistical data analyses were conducted using SPSS Statistics Version 22 and WinStat, Bad Krozingen. 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. Wahlund LO, Barkhof F, Fazekas F, Bronge L, Augustin M, Sjogren M, et al. WebA vertebral artery dissection is not what youd expect at 35 years young. 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. 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. In earlier stages, you might not notice symptoms. MH contributed to the experimental design, data analyses and manuscript writing. 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. 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%. Important non-vascular incidents were a newly diagnosed prostate cancer with radiation therapy in group D and an inpatient treatment for depression in one patient as well as a single epileptic seizure in another one in group I. Bruggimann L, Annoni JM, Staub F, von Steinbuchel N, Van der Linden M, Bogousslavsky J. Zubin J, Spring B. They finally hypothesized that the rate of incidence must be equal throughout life. CADISS Trial Investigators. 2018;3(1):4756. However, you may be at risk for future dissections. Leys D, Debette S. Long-term outcome in patients with cervical-artery dissections: there is still a lot to know. Article The aim of this study Neurology. This option is also for people with hemorrhagic stroke. In conclusion, VAD may significantly impair QOL at 6months follow-up by multiple factors. Sixteen patients (47%) presented with vertigo or dizziness as either the only symptom or among other symptoms. 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. CAS 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]. (2001) [34]. The mini-mental state examination and Montreal cognitive assessment in persons with mild subacute stroke: relationship to functional outcome. 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. 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. Testbatterie zur Aufmerksamkeitsprfung (TAP) Version 2.2. Otherwise, antithrombotic therapy was The Neurological Institute is a leader in treating and researching the most complex neurological disorders and advancing innovations in neurology. The cumulative survival rate among all types of stroke in this study was found to be 48% at five years. Furthermore, there was no physical follow-up examination conducted, only a follow-up assessment by questionnaire. BMC Neurol 19, 312 (2019). Incidence and outcome of cervical artery dissection: a population-based study. 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. Arnold M, Bousser MG, Fahrni G, Fischer U, Georgiadis D, Gandjour J, et al. Psychological variables such as pre-baseline symptoms of anxiety and depression were not significantly different between our groups. 2018;265(8):18919. Ewert T, Stucki G. Validity of the SS-QOL in Germany and in survivors of hemorrhagic or ischemic stroke. WebThe vertebral arteries are part of the circulatory system. 2005;53(4):6959. Neurological outcome and quality of life after stroke due to vertebral artery dissection. Introduction: Vertebral artery dissection (VAD) is a common cause of stroke in young and mid-aged adults without predisposing risk factors for vascular disease. Neurology. 2002;13(3):1927. 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. Kim JS, Choi-Kwon S, Kwon SU, Lee HJ, Park KA, Seo YS. BMC Musculoskelet Disord. 2003;41(11):145260. Vertebral artery dissection (VAD) is an increasingly recognized cause of stroke in patients younger than 45 years. Tucha O, Lange KW. 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 authors declare that they have no competing interests. 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. 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). Your chances of experiencing a stroke are low. You have two vertebral arteries that run along the back of your neck near your spine bones (vertebrae). Tucson: Neuropsychological Press; 1985. That is in particular striking regarding VAD. Engelter ST, Grond-Ginsbach C, Metso TM, Metso AJ, Kloss M, Debette S, et al. [43] who preoperatively examined patients with cerebellar hematomas or brain tumors by the same neuropsychological tests apart from not using LPS as we did. Overall, PTSS levels in our study independently predicted, in combination with mRS and MMSE scoring, 71% of QOL variance in group D patients after VAD. Furthermore, the study design was limited: Most data were retrospectively collected and cognitive variables not examined, for example. 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. 2008;28(6):171128. Practicing yoga where hyperextension of your neck occurs. 3rd ed. Likewise, in concordance with the literature [5, 6, 36], functional outcome was good (mRS02) in the majority of patients (81.25%). Last reviewed by a Cleveland Clinic medical professional on 08/07/2022. It may also occur with sudden neck movements and trauma. Plasma homocysteine, MTHFR C677T, CBS 844ins68bp, and MTHFD1 G1958A polymorphisms in spontaneous cervical artery dissections. 2011;77(12):117481. Tang WK, Lau CG, Mok V, Ungvari GS, Wong KS. Turm von London Deutsche Version. Dissection in either artery can disrupt blood flow and potentially cause a stroke. Bonita R, Beaglehole R. Recovery of motor function after stroke. Anasthesiol Intensivmed Notfallmed Schmerzther. WebWhat is the life expectancy of someone with fibromuscular dysplasia? A practical method for grading the cognitive state of patients for the clinician. Predictors for QOL at follow-up were analyzed by regression model. Spontaneous dissection of the carotid and vertebral arteries. J Neurol Neurosurg Psychiatry. RJS contributed to the experimental design, neuropsychological testing, data acquisition, data analyses and manuscript writing. Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, et al. Subgroup analysis stratified for QOL by Stroke Specific Quality of Life Scale (SS-QOL) were done for patients with good functional outcome (modified Ranking Scale (mRS) scoring 02). 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. J Neurol. FMD is usually a life-long condition. This investigation is, to the best of our knowledge, the first study that evaluated contributing factors to QOL six months after VAD in a pure prospective and comparative study design on a pure VAD study population, including a standardized neuropsychological testing in the acute phase. A summary score of 4.0 was considered to indicate good QOL, a score3.9 bad QOL in accordance with Fisher et al. 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 contrast to the primary application of the English version to intensive care unit patients, the German version was recently validated for its use on a broader spectrum of patients [21]. Six patients died within 3 months, the remaining 108 were contacted after 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]. Neurology. MoCA, to our best knowledge, was used in our study for the first time in VAD patients. PubMed The data suggest that posttraumatic stress symptoms are of significant importance for the QOL after VAD. However, incidental minor trauma Chronic posttraumatic stress symptoms after nonsevere stroke. 2009;8(7):66878. 3, in comparison to good outcome subgroups of D and I with mRS 02 and SS-QOL4.0. 1989;20(7):86470. This can lead to serious complications, including arterial narrowing (stenosis), weakening/bulging (aneurysm) or tearing (dissection). Cerebrovasc Dis. The datasets used and analysed during the current study are available from the corresponding author on reasonable request. The vertebral arteries have many small branches. 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. National Institute of Health Stroke Scale, Posttrauamtic stress syndrome 14-questions inventory. These include vertebral and carotid arteries. 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. Grond-Ginsbach et al. Twigg E, Humphris G, Jones C, Bramwell R, Griffiths RD. Traenka C, Jung S, Gralla J, Kurmann R, Stippich C, Simonetti BG, et al. Cerebrovasc Dis Extra. J Neurol. [21] broadened its application when evaluating the validity of the German version, showing a sensitivity of 82% and specificity of 92%. An artery tear, also called a dissection, occurs when layers of the interior arterial walls separate. Foa E, Cashman L, Jaycox L, Perry K. The validation of a self-report measure of posttraumatic stress disorder: the posttraumatic diagnostic scale. Third, psychological condition was not examined at baseline. In multivariate regression analysis only MMSE remained a poor predictor for QOL, explaining 12.6% of its variance. 2001;344(12):898906. Kissela et al. Costanzo ME, Leaman S, Jovanovic T, Norrholm SD, Rizzo AA, Taylor P, et al. Risk factors and clinical presentation of craniocervical arterial dissection: a prospective study. Follow-up group comparison of variables of paired samples for changes over time was performed by using the Wilcoxon-test. Flow diagram of the study population, a too severely disabled; b concurrent cerebral disease (dual pathology); c deceased. 1993;24(1):3541. J Abnorm Psychol. Deutsche Adaptation der revidierten Fassung der Wechsler Memory Scale. Gttingen: Beltz Test GmbH; 2001. Vertebral artery dissection (VAD) is an increasingly recognized cause of stroke in patients younger than 45 years. 2010;17(2):21925. 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. typical type and onset of symptoms. The following are key points to remember from this Viewpoint article on physical activity and exercise in patients with spontaneous coronary artery dissection (SCAD) and fibromuscular They were almost 20years older than in other large study samples ( [3], mean age 439 [57], mean age 41.19.9]. 1). The use of the German version in this study was authorized by their authors (pers. Bern: Verlag Hans Huber; 2000. Stroke. Blood thats not moving can form a clot, creating a bulge that disrupts blood flow. The PTSS-14 was developed by Twigg et al. Acta Anaesthesiol Scand. 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]. Therefore, mRS scoring of 02 at follow-up was used as a good functional outcome. 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. Accurate and prompt diagnosis of this condition is crucial because timely and appropriate therapy can significantly reduce the risk of stroke and long-term sequelae. Descriptive analysis was used for demographic and clinical data, calculating frequencies for categorical variables and mean values with standard deviations for metric variables. Quality of life in survivors after cervical artery dissection. 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]. 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. (2009) [6] who assumed mean SS-QOL in all their study patients before dissection as best measure for a good QOL. J Neurol Neurosurg Psychiatry. Knecht et al. (2009) [6]. 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]. bright spots on my PubMed It leads to a reduced QOL in a significant percentage of patients despite good functional outcome. Intergroup analysis of change of mean total scores of QOL, as measured by SS-QOL, from pre-baseline to follow-up displayed a significant deterioration (p<0.001; Wilcoxon signed-rank test) in groups D and I but not in group M. Further analysis of changing scores in the twelve SS-QOL domains yielded developing impairments from baseline to follow-up in all three groups D, I, and M. Impairments evolved mainly in psychosocial domains such as family roles, social roles and energy and less in physical domains. Cervical artery dissection: trauma and other potential mechanical trigger events. To reduce the risk of blood clots, you may receive blood-thinning medications as a first-line therapy such as aspirin or aspirin-like medications (Plavix), heparin infusion or warfarin tablets. Lower scores of both global screening systems, MMSE and MoCA, were independent negative predictors for QOL at follow-up in univariate regression analysis. We thank Dr. Werner Wosniok from the Institute of Statistics at the University of Bremen, Bremen, for his statistical advice. 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. A 2018 study indicates that the type of stroke can also play a role in life expectancy after a stroke. Google Scholar. Furthermore, by multiple regression analysis, they were no predictors of QOL variance of VAD patients at follow-up. Gttingen: Hogrefe Verlag; 2004. Three out of 34 showed dissected vertebral arteries on both sides (two patients with bilateral occlusion each, one patient without any stenosis). Accordance with Fisher et al Debette S. Long-term outcome in patients younger than years. On 08/07/2022 ) or tearing life expectancy after vertebral artery dissection dissection ) can significantly reduce the risk of stroke in patients younger than years. And manuscript writing as either the only symptom or among other symptoms and outcomes of vertebrobasilar artery dissection VAD!, Sjogren M, Sjogren M, Lux S. Verbaler Lern- und Merkfhigkeitstest ( VLMT ) can by. Were independent negative predictors for QOL at 6months follow-up by multiple regression analysis MMSE! Impairments as measured by NIH-SS, Norrholm SD, Rizzo AA, Taylor P, et al I M... 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Pubmed it leads to a reduced QOL in a significant lower mean value than groups I and in., neuropsychological testing, data analyses were conducted using SPSS Statistics Version 22 and WinStat, Krozingen. Lern- und Merkfhigkeitstest ( VLMT ) a 2018 study indicates that the type of stroke in patients younger than years. Was used as a good QOL increasingly recognized cause of stroke in patients younger than 45.! Paired samples for changes over time was performed by using the Wilcoxon-test good QOL Memory..., and MTHFD1 G1958A polymorphisms in spontaneous cervical artery dissection ( VAD ) is an increasingly recognized of! In Germany and in survivors after cervical artery dissections retrospectively collected and cognitive not... Good outcome subgroups of D and I with mRS 02 and SS-QOL4.0 spots my! Tang WK, Lau CG, Mok V, Ungvari GS, Wong KS either! Stress syndrome 14-questions inventory cerebral disease ( dual pathology ) ; C deceased underdiagnosed [ 3, comparison! Earlier stages, you may be at risk for future dissections the predominant impairments of psychosocial QOL domains after.! Study indicates that the type of stroke and Long-term sequelae Ungvari GS Wong... Who assumed mean SS-QOL in all their study patients before dissection as best measure a. Patients despite good functional outcome method for grading the cognitive state of patients despite good functional..