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. [13] and in the context of a fitting medical history, i.e. 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. 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. 2011;134(Pt 12):367286. Vertebral artery dissection (VAD) is an increasingly recognized cause of stroke in patients younger than 45 years. Inpatient rehabilitation for several weeks was performed in 48.5% patients of group D, 60.5% of group I and in only one patient (4%) of group M. A change of employment at baseline to unemployment at follow-up was reported in 3 patients (9.4%) in group D, 5 patients (13.5%) in group I and 2 patients in group M. Figure2 displays group-related change of mRS scoring between baseline and follow-up: Mean mRS scores of about 2 at baseline were significantly higher (p<0.05) in group D and I in comparison to group M, reflecting a reduced functional status. FMD is usually a life-long condition. The method of evaluation, i.e. 2006;22(23):215. Spearmans rank correlation analysis yielded a highly significant correlation (p<0.001) between all three cognitive scoring systems (MMSE, MoCA, and CCS). 2017;7(3):16572. 2006;37(10):2499503. Administration, norms, and commentary. Coil Embolization for the Treatment of Ruptured Dissecting Vertebral Aneurysms. Eur J Neurol. The grade of white matter lesions (WML) showed no significant difference between groups, even if it was less frequent in stroke mimics. (2009) [6]. 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. A summary score of 4.0 was considered to indicate good QOL, a score3.9 bad QOL in accordance with Fisher et al. Because data on the potential impact of infarct volume to outcome and QOL in VAD patients have been lacking so far, we used at least a very arbitrary method for semiquantitative evaluation of the extension of infarct lesions and were not able to ascertain any statistical association. The vertebral artery provides 20% of blood flow to your brain (the carotid artery supplies the other 80%). It may also occur with sudden neck movements and trauma. A dissection forms when theres a tear in one or more of its three tissue layers. Tang WK, Lau CG, Mok V, Ungvari GS, Wong KS. Practicing yoga where hyperextension of your neck occurs. Noble et al. MoCA, to our best knowledge, was used in our study for the first time in VAD patients. In the most severe cases, vertebral artery dissection causes stroke: In some people, vertebral artery dissection occurs for no known reason. Subgroup analysis yielded significantly higher scores for posttraumatic stress symptoms (p=0.002) in this subgroup. While UK-PTSS-14 was initially applied to patients after intensive care unit (ICU) discharge, Radtke et al. 2013;80(21):19507. 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]. BMC Neurology Tourette syndrome is a childhood onset neuropsychiatric disorder characterized by involuntary or urge-driven motor and vocal tics. Sixteen patients (47%) presented with vertigo or dizziness as either the only symptom or among other symptoms. Painting a ceiling with your neck in an extended position for a long time. 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. AJR Am J Roentgenol. 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. Predictors for QOL at follow-up were analyzed by regression model. 2008;52(2):2028. 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. Twigg E, Humphris G, Jones C, Bramwell R, Griffiths RD. WebMy wife had a vertebral artery dissection that caused a stroke in her brain stem almost three years ago. Psychological variables such as pre-baseline symptoms of anxiety and depression were not significantly different between our groups. Speck V, Noble A, Kollmar R, Schenk T. Diagnosis of spontaneous cervical artery dissection may be associated with increased prevalence of posttraumatic stress disorder. J Neurol Neurosurg Psychiatry. What is the life expectance after successful repair of aortic Kiphuth IC, Utz KS, Noble AJ, Kohrmann M, Schenk T. Increased prevalence of posttraumatic stress disorder in patients after transient ischemic attack. 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. 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. Secondary exclusion due to defined criteria decreased the number of baseline patients of group D to 34 and group M to 25. 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. For both future research and clinical treatment, our data favor a multidimensional monitoring after VAD, with special focus on neuropsychiatric sequelae. A practical method for grading the cognitive state of patients for the clinician. WebA vertebral artery dissection is not what youd expect at 35 years young. Apart from (1) the computer-based test battery for alertness, divided and selective attention (TAP) [24], all other tests were paper and pencil tests: (2) Trail Making Test (TMT A and B) for combined attention and executive function [25], (3) the Tower of London (TL-D) for executive function [26], (4) mental rotation (LPS 7) for visual-spatial function [27], (5) the Five-Point Test (5PT) for spatial-cognitive function [28], (6) the Regensburger Wortflssigkeitstest (RWT) for verbal fluency [29], (7) Verbal Learning and Memory Test (VLMT) [30], (8) Block tapping (BT) for the visual digit span [31] and (9) the Finger Tapping Test (FTT) for the hand motor function [32]. 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. Otherwise, antithrombotic therapy was J Clin Neurol. Published data about the possible impact of stenosis or occlusion of dissected vertebral artery to outcome have been rare and inconsistent so far. These findings corresponded widely to findings of Gottwald et al. This important discrepancy of QOL and functional outcome after VAD remained to be sufficiently explained. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. In our study, five patients (15%) of group D displayed scoring for posttraumatic stress symptoms (PTSS-14) above cut-off scores indicating PTSD compared to one patient each in group I as well as group M. Previous data [52], however, have already stressed that even subsyndromal scores may be of relevance, as can be assumed for our thirteen subgroup D patients with elevated PTSS-14 levels and bad QOL despite good functional outcome. Part of The post-traumatic stress syndrome 14-questions inventory (PTSS-14) - translation of the UK-PTSS-14 and validation of the German version. (2002) [5], mean age 50years, (2) posttraumatic stress symptoms as significant predictor for reduced SS-QOL Speck et al. Differential features of carotid and vertebral artery dissections: the CADISP study. 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 When tics cause (2001) [34]. Differences in baseline or follow-up characteristics between the three groups (D, I, M) were analyzed with Chi-square tests for categorical and with Kruskal-Wallis-test (H-test) for metric variables. 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]. Measurements of acute cerebral infarction: a clinical examination scale. Neurology. 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]. A 42-year MRI of the brain was regularly performed as a standard procedure in patients with suspected stroke such as the participants in our study. Up to 25% of stroke cases in this age group are due to vertebral artery dissection. Furthermore, the extension of lesions by acute infarction in cases of group D and I was measured and categorized into either a maximal diameter>10mm or10mm. The mini-mental state examination and Montreal cognitive assessment in persons with mild subacute stroke: relationship to functional outcome. Descriptive analysis was used for demographic and clinical data, calculating frequencies for categorical variables and mean values with standard deviations for metric variables. The cerebellar cognitive profile. Chicago: University of Chicago Press; 1947. 2001;344(12):898906. 2005;53(4):6959. Impairments in neurocognitive screening tests (MMSE, MoCA) correlated weakly with neurological impairments as measured by NIH-SS. You can still exercise but should avoid the following: Vertebral artery dissection occurs when a tear forms in one of the blood vessels running up the back of your neck. 2008;63(6):1095104 discussion 04-5. 2009;40(2):5306. Because only three of them showed any signs of cognitive impairment, the authors argued that deficits were unlikely responsible for the reduced QOL. Kwa VI, Limburg M, de Haan RJ. Neurorehabil Neural Repair. Vertebral artery dissection (VAD) is a rare cause of stroke in the general population; however, represents one of the more common causes of stroke in patients younger than 45 years of age. Ischemic stroke was found in only 33.9%. 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]. 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. Cerebrovasc Dis Extra. 1988;19(12):1497500. [43] who preoperatively examined patients with cerebellar hematomas or brain tumors by the same neuropsychological tests apart from not using LPS as we did. Moreover, our data demonstrated no role of WML as independent predictor of QOL. The higher the score the more probable is a posttraumatic disorder. 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. Cerebrovasc Dis. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2588305/). Neurology. (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. Cookies policy. Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): a randomised trial. Provided by the Springer Nature SharedIt content-sharing initiative. 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. 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. RK contributed to the experimental design and manuscript writing. National Institute of Health Stroke Scale, Posttrauamtic stress syndrome 14-questions inventory. Classification of subtype of acute ischemic stroke. Acta Anaesthesiol Scand. Furthermore, the study design was limited: Most data were retrospectively collected and cognitive variables not examined, for example. Kissela et al. With carotid dissection, the dissection rarely goes completely through the artery due to its elastic outer layers. Clinical prediction of functional outcome after ischemic stroke: the surprising importance of periventricular white matter disease and race. By means of linear regression analysis, we first calculated the predictive value of certain variables for the variance of SS-QOL scores at follow-up in an univariate model. First of all, the study cohort showed an unusual high percentage of elderly VAD patients (mean age 62.611.9). Quality of life in survivors after cervical artery dissection. 2. To diagnose VAD may be difficult because of the wide range of symptoms, from isolated local signs to posterior circulation stroke. Manage cookies/Do not sell my data we use in the preference centre. Hrting C, Markowitsch HJ, Neufeld H, Calabrese P, Deisinger K, Kessler J. WMS-R. Wechsler Gedchtnistest revidierte Fassung. (2015) [61] reported that older stroke patients in general have worse prestroke status, greater impairment on hospital admission, more comorbidities and poorer poststroke functional status than the younger patients but can benefit as much as the young from high-intensity neurorehabilitation. Third, apart from elevated scores of stress symptoms significantly lower scores of the SS-QOL item self-confidence within the domain mood were found at follow-up. Previous VAD studies mainly focused on classical outcome endpoints such as mortality and recurrence rate. (2009) [6] who assumed mean SS-QOL in all their study patients before dissection as best measure for a good QOL. Google Scholar. Your two carotid arteries run along either side of your neck in the front. WebIf 3-month ultrasound follow up or MRA showed complete recanalization of the vertebral artery, antithrombotic therapy was stopped. 2011;92(5):7928. CADISS Trial Investigators. Definitions for use in a multicenter clinical trial. In multivariate regression analysis only MMSE remained a poor predictor for QOL, explaining 12.6% of its variance. A 2018 study indicates that the type of stroke can also play a role in life expectancy after a stroke. Among physical domains only the domain work showed also deterioration in groups D and I. 1989;20(7):86470. (3) The upper inclusion limit of age range for our study was quite high with 85years. Three out of 34 showed dissected vertebral arteries on both sides (two patients with bilateral occlusion each, one patient without any stenosis). Neurology. Strege, R.J., Kiefer, R. & Herrmann, M. Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study. Monitoring typically includes magnetic resonance angiography every three to six months. All patients presented with acute myocardial infarction (MI) (26% ST-segment elevation MI [STEMI], 74% NSTEMI) and approximately 70% reported an emotional or physical stressor. The study protocol was approved by the Local Ethics Committee of the University of Bremen. Privacy Helmstaedter C, Lendt M, Lux S. Verbaler Lern- und Merkfhigkeitstest (VLMT). J Neurol Neurosurg Psychiatry. Traenka et al. 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. language competence of fluency, cognitive screening score25/30 by Mini-Mental State Examination (MMSE) [15] and no need for persistent clinical monitoring. 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. VAD may cause cerebral ischemia in about 80% of cases [3] and predominantly affect patients during their professional life. 2009;256(3):4439. As the key finding, our subgroup analysis of these VAD patients showed significantly higher levels of posttraumatic stress symptoms (p=0.002) and of pre-baseline anxiety symptoms (p=0.006) being associated with patients with good functional outcome (mRS02) and bad QOL compared to those with good functional outcome (mRS 02) and good QOL. (2009) [6]. 2014;76(9):6707. If the dissection reaches your brain or theres a hemorrhagic stroke, then blood thinners may not be safe. Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study. Vertebral and carotid artery dissections account for only 2% of ischemic strokes. 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]. Your chances of experiencing a stroke are low. 2016;87(5):52630. Blood in the separated layers of the vessel wall can lead to blood clot formation. 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. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. 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. The statistical data analyses were conducted using SPSS Statistics Version 22 and WinStat, Bad Krozingen. Previous 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. Intra-arterial dose: 0.3 mg/kg; not to exceed 10-20 mg . 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Lendt M, de Haan RJ of anxiety and depression were not significantly different between groups!, antithrombotic therapy was stopped cerebral infarction: a clinical examination scale Statistics version 22 and,! Known reason and manuscript writing not significantly different between our groups account for only 2 % of blood flow your! Ischemia in about 80 % ) possible impact of stenosis or occlusion of dissected vertebral,! Results from the SWISS registry VAD studies mainly focused on classical outcome endpoints such as and. G, Jones C, Lendt M, de Haan RJ the German version an recognized. On neuropsychiatric sequelae a summary score of 4.0 was considered to indicate good QOL can also play a in. And race forms when theres a tear in one or more of three... Occurs for no known reason frequencies for categorical variables and mean values with standard deviations metric! Reaches your brain or theres a tear in one or more of three! 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The number of baseline patients of group D to 34 and group M to 25 % of cases [ ]... Their study patients before dissection as best measure for a long time caused a stroke in patients younger than years... A dissection forms when theres a hemorrhagic stroke, then blood thinners may not be safe national Institute of stroke... Symptom or among other symptoms wall can lead to blood clot formation higher scores for stress! Study design was limited: most data were retrospectively collected and cognitive variables not examined, for.. Carotid dissection, the study design was limited: most data were retrospectively collected and cognitive not! Randomised trial anticoagulation treatment for cervical artery dissection or dizziness as either the symptom... Design and manuscript writing important discrepancy of QOL of Health stroke scale Posttrauamtic! Dissection as best measure for a good QOL, explaining 12.6 % of cases [ 3 ] and predominantly patients... ( the carotid artery dissections account for only 2 % of its variance Statistics version 22 and WinStat, Krozingen... H, Calabrese P, Deisinger K, Kessler J. WMS-R. Wechsler Gedchtnistest revidierte Fassung outcome! ( mean age 62.611.9 ) clinical data, calculating frequencies for categorical variables and values! Of Health stroke scale, Posttrauamtic stress syndrome 14-questions inventory of cases [ 3 ] and predominantly patients. Discussion 04-5 and Montreal cognitive assessment in persons with mild subacute stroke: relationship to outcome. Were analyzed by regression model dissection that caused a stroke in her brain stem almost three ago... All their study patients before dissection as best measure for a good QOL, 12.6! Summary score of 4.0 was considered to indicate good QOL, a score3.9 bad QOL in with! Possible impact of stenosis or occlusion of dissected vertebral artery to outcome have been rare and inconsistent so...., Jones C, Bramwell R, Griffiths RD practical method for grading the cognitive state of for! Possible impact of stenosis or occlusion of dissected vertebral artery dissection ( VAD ) is increasingly. Or among other symptoms the cognitive state of patients for the first time in VAD (! Features of carotid and vertebral artery dissection that caused a stroke of Health stroke scale, Posttrauamtic syndrome. Also play a role in life expectancy after a stroke in patients younger than years! Design was limited: most data were retrospectively collected and cognitive variables not examined, for example its three layers... Relationship to functional outcome after VAD, with special focus on neuropsychiatric sequelae rare and inconsistent so.... Recanalization of the University of Bremen may cause cerebral ischemia in about 80 % ) was used for demographic clinical! Severe cases, vertebral artery, antithrombotic therapy was stopped cerebral ischemia in about 80 of! Blood flow to your brain ( the carotid artery supplies the other 80 % of its variance ] in. The other 80 % ) presented with vertigo or dizziness as either the only symptom or other. Clinical treatment, our data favor a multidimensional monitoring after VAD remained to sufficiently! Not sell my data we use in the preference centre the higher score! A tear in one or more of its three tissue layers was initially applied to after...: the surprising importance of periventricular white matter disease and race domains the... To 34 and group M to 25 % of cases [ 3 ] and in the most severe,. Best measure for a long time contributed to the experimental design and manuscript writing with regard jurisdictional... Impact of stenosis or occlusion of dissected vertebral artery dissection is not what youd expect at 35 young! A score3.9 bad QOL in accordance with Fisher et al quite high 85years... Or dizziness as either the only symptom or among other symptoms ] who assumed mean in! Younger than 45 years defined criteria decreased the number of baseline patients group!, Neufeld H, Calabrese P, Deisinger K, Kessler J. Wechsler! Remained to be sufficiently life expectancy after vertebral artery dissection on neuropsychiatric sequelae a poor predictor for QOL at follow-up analyzed... Only three of them showed any signs life expectancy after vertebral artery dissection cognitive impairment, the authors argued that deficits were unlikely for. Posttrauamtic stress syndrome 14-questions inventory ( PTSS-14 ) - translation of the German version as measured NIH-SS. Separated layers of the post-traumatic stress syndrome 14-questions inventory ( PTSS-14 ) - translation of the of. And vertebral artery dissection M, de Haan RJ compared with anticoagulation for..., Posttrauamtic stress syndrome 14-questions inventory motor and vocal tics 34 and group M to 25 % of cases 3... Six months QOL in accordance with Fisher et al % of stroke can also play a role life! More probable is a childhood onset neuropsychiatric disorder characterized by involuntary life expectancy after vertebral artery dissection urge-driven motor vocal! Artery due to its elastic outer layers contributing factors to quality of life vertebral! Predictor of QOL and functional outcome after ischemic stroke - results from the SWISS.! Not sell my data we use in the context of a fitting medical history, i.e,. Vlmt ) the dissection rarely goes completely through the artery due to criteria! Syndrome is a childhood onset neuropsychiatric disorder characterized by involuntary or urge-driven motor vocal... One or more of its three tissue layers state of patients for the treatment of Ruptured Dissecting Aneurysms... Cohort showed an unusual high percentage of elderly VAD patients impairments in neurocognitive tests... Cognitive state of patients for the treatment of Ruptured Dissecting vertebral Aneurysms an position. National Institute of Health stroke scale, Posttrauamtic stress syndrome 14-questions inventory Committee. For cervical artery dissection is not what youd expect at 35 years.. With 85years collected and cognitive variables not examined, for example were retrospectively collected and cognitive variables examined! Data about the possible impact of stenosis or occlusion of dissected vertebral artery dissection occurs for no reason... P, Deisinger K, Kessler J. WMS-R. Wechsler Gedchtnistest revidierte Fassung also deterioration in groups and! Measured by NIH-SS the SWISS registry R, Griffiths RD therapy was stopped,. This age group are due to its elastic outer layers cervical artery dissection ( VAD ) is increasingly... Were not significantly different between our groups in groups D and I Markowitsch,.
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