Likewise, there was no statistical group difference of the mean values of the total quality of life score measured by SS-QOL. The higher the score the more probable is a posttraumatic disorder. Subgroup analysis yielded significantly higher scores for posttraumatic stress symptoms (p=0.002) in this subgroup. But its still a dangerous situation. If the dissection reaches your brain or theres a hemorrhagic stroke, then blood thinners may not be safe. While SS-QOL at follow-up was normal and corresponded to pre-baseline in stroke mimics, SS-QOL scores significantly worsened in group D and I patients, mainly in the psychosocial domains. Gttingen: Hogrefe Verlag; 2000. Speck et al. 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. Craniocervical artery dissection is a potentially disabling yet probably underrecognized condition that often occurs in young and middle-aged adults. Psychophysiological response to virtual reality and subthreshold posttraumatic stress disorder symptoms in recently deployed military. MH contributed to the experimental design, data analyses and manuscript writing. 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 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). Kissela et al. These include vertebral and carotid arteries. Magnetic resonance angiography is the gold standard diagnostic test. 1975;12(3):18998. Williams LS, Weinberger M, Harris LE, Biller J. Speck et al. The risk of dying can be as high as 1% to 3% per hour until the patient gets treatment. Grond-Ginsbach et al. (3) The upper inclusion limit of age range for our study was quite high with 85years. Previous Published data about the possible impact of stenosis or occlusion of dissected vertebral artery to outcome have been rare and inconsistent so far. GA compendium of neuropsychological tests. On rare occasions, this can lead to stroke. (2014) [46]. WebScore: 4.2/5 (61 votes) . Neuropsychologia. 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]. Anasthesiol Intensivmed Notfallmed Schmerzther. It combines magnetic resonance imaging (MRI) with angiography to capture detailed images of your vertebral arteries. There were significant more neurological impairments at baseline, that are higher scores of mRS for functional disability or NIH-SS for neurological deficit, in group D as well as I patients with ischemic stroke lesions compared to stroke mimics. PubMed This profile of cognitive dysfunction was related to predominance of cerebellar stroke lesions in both group D and group I. Background: Vertebral artery dissection (VAD) may cause cerebral ischemia and impair quality of life (QOL) despite of good functional outcome. 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. (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. This process usually occurs within the first three to six months. 2005;53(4):6959. Ahl et al. The mean decrease of QOL, that is the difference of SS-QOL scoring, from pre-baseline to follow-up, was significantly stronger in the subgroups (mRS 02) with bad quality of life (SS-QOL3.9). The finding of more neurocognitive impairments in form of lower mean values in cognitive measures in patients with ischemic lesions of both group D and group I patients did not reach significance. Quality of life in survivors after cervical artery dissection. 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]. (2013) [59] hypothesized that cervical artery dissection goes frequently undiagnosed, particularly in patients with subtle symptoms, which is true for VAD [3, 57], and dependently from the awareness of the responsible physician. 2. Because recurrence of stroke or dissection is very low despite a mostly lacking morphological artery recanalization and it is nearly limited to the first weeks after dissection, it was questioned by Leys and Debette (2006) [4] what are the appropriate clinical monitoring parameters for follow-up. Kissela B, Lindsell CJ, Kleindorfer D, Alwell K, Moomaw CJ, Woo D, et al. Czechowsky et al. What symptoms/pain did you experience? Neurorehabil Neural Repair. This option is also for people with hemorrhagic stroke. WebIf 3-month ultrasound follow up or MRA showed complete recanalization of the vertebral artery, antithrombotic therapy was stopped. The method of evaluation, i.e. 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. Czechowsky D, Hill MD. Mean values of mRS scoring improved from baseline to follow-up in all three groups but significantly only in group I. 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]. No individual persons personal details, images or videos are being used in this study. Deutsche Adaptation der revidierten Fassung der Wechsler Memory Scale. Neurology. In the most severe cases, vertebral artery dissection causes stroke: In some people, vertebral artery dissection occurs for no known reason. While UK-PTSS-14 was initially applied to patients after intensive care unit (ICU) discharge, Radtke et al. Events most commonly occur in the postpartum period Practicing yoga where hyperextension of your neck occurs. Patients most commonly present with neck pain, headache, visual disturbance, or focal extremity weakness. In addition, differentiation of dissection from rupture of atheroma in the context of arteriosclerosis may be difficult so that Ahl et al. WebDuplex ultrasound is a reliable noninvasive technique for the evaluation of the vertebral arteries. 1997;9:44551. 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. Cite this article. This exploratory study was carried out in the Neurological Department of the University-affiliated teaching hospital AGAPLESION Diakonieklinikum Rotenburg, Germany. 1997;19(1):612. The study protocol was approved by the Local Ethics Committee of the University of Bremen. Depending from the availability of imaging techniques such as magnetic resonance imaging (MRI) angiography as well as the awareness of physicians VAD has been increasingly diagnosed in recent years. All authors read and approved the final manuscript. (2004) [58] proposed the term of atherosclerotic dissection for certain cases. 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. Their mixed series included about two third of patients with spontaneous internal carotid artery dissection (ICAD) and one third with VAD. On rare occasions, this can lead to stroke. Vulnerability--a new view of schizophrenia. Exner C, Weniger G, Irle E. Cerebellar lesions in the PICA but not SCA territory impair cognition. 2014;45(11):33606. Healthcare providers can often diagnose a vertebral artery dissection with a computed tomography (CT) scan or CT angiography. 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. (2014) [46] very recently reported for the first time a high prevalence of 45.2% patients meeting the diagnostic criteria for PTSD after cervical artery dissection compared to 2.9% in the general German population. 2011;134(Pt 12):367286. The second data collection was achieved by written standardized, structured questionnaire at follow-up (time point t2) 6months after the initial event. Acta Anaesthesiol Scand. 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. 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]. The vertebral artery provides 20% of blood flow to your brain (the carotid artery supplies the other 80%). They most probably reflected stroke lesion-associated cognitive impairments whereas stroke mimics without any lesions did show normal scores. Policy. MRI of the brain was regularly performed as a standard procedure in patients with suspected stroke such as the participants in our study. The statistical data analyses were conducted using SPSS Statistics Version 22 and WinStat, Bad Krozingen. 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. 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). Trial of org 10172 in acute stroke treatment. Disabil Rehabil. Google Scholar. 2008;63(6):1095104 discussion 04-5. 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). 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. They were almost 20years older than in other large study samples ( [3], mean age 439 [57], mean age 41.19.9]. Patients with suspected cervical artery dissection received additional angiography, mainly MRI angiography, if there has not been already evident cranial computer tomography or even conventional angiography. 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]. Konrad C, Muller GA, Langer C, Kuhlenbaumer G, Berger K, Nabavi DG, et al. Psychol Assess. Hrting C, Markowitsch HJ, Neufeld H, Calabrese P, Deisinger K, Kessler J. WMS-R. Wechsler Gedchtnistest revidierte Fassung. Otherwise, antithrombotic therapy was 2003;250(10):117984. Study participants were asked at follow-up to answer 14 items of the PTSS-14 inventory regarding stress symptoms in the previous week. Painting a ceiling with your neck in an extended position for a long time. Cervical artery dissection, including VAD and carotid artery dissection, are rare complications of pregnancy. Foa E, Cashman L, Jaycox L, Perry K. The validation of a self-report measure of posttraumatic stress disorder: the posttraumatic diagnostic scale. Exclusion criteria were as follows: (1) VAD due to severe trauma - in contrast to conventionally as spontaneous labeled dissection due to minor prior cervical trauma which should be better termed mechanical trigger event according to Engelter et al. 2010;17(2):21925. Six patients died within 3 months, the remaining 108 were contacted after 2008;52(2):2028. Vertebral artery dissection (VAD) is an increasingly recognized cause of stroke in patients younger than 45 years. Thomas LC, Rivett DA, Attia JR, Levi CR. Med Hypotheses. Reitan RM, Wolfson D. The Halstead-Reitan neuropsychological test battery: therapy and clinical interpretation. (2008) [47] in the United Kingdom (UK) as a new, more practical screening tool for post-traumatic stress disorder (PTSD). Costanzo ME, Leaman S, Jovanovic T, Norrholm SD, Rizzo AA, Taylor P, et al. 2002;13(3):1927. 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. Google Scholar. Cerebrovasc Dis Extra. J Neurol Neurosurg Psychiatry. Vertebral artery dissection (VAD) is an increasingly recognized cause of stroke in patients younger than 45 years. (2014) [46] were the only other ones to date who recently published cognitive status data of patients after cervical artery dissection. Brain and intelligence: a quantitative study of the frontal lobes. Likewise, in concordance with the literature [5, 6, 36], functional outcome was good (mRS02) in the majority of patients (81.25%). Procedures for vertebral artery dissection include: Most people make a full recovery. statement and Cleveland Clinic is a non-profit academic medical center. These are typically among the first tests people receive. 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. 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. You may also need to continue taking a blood thinner during this time. The type of cause for ischemia in the group I was categorized according to the TOAST criteria [14]. 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. Neurology. 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. This important discrepancy of QOL and functional outcome after VAD remained to be sufficiently explained. In some cases, cerebellum and medulla oblongata were affected in combination. Kim JS, Choi-Kwon S, Kwon SU, Lee HJ, Park KA, Seo YS. All participants were informed about the procedure and gave written informed consent to participate in the study. Finding Support, the Right Doctor, and Some Validation The months following that fateful workout session were a 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. Their high PTSD prevalence might be overestimated because physically less affected people voluntarily participating in their study might have tended to mention more mental problems when asked by self-rating PDS. A 2018 study indicates that the type of stroke can also play a role in life expectancy after a stroke. A Spearmans rank correlation analysis was performed for outcome-relevant variables. 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). Cervical artery dissection: trauma and other potential mechanical trigger events. 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 our study, there was a trend in patients with good functional outcome (mRS score 02) to higher association of occlusion/subtotal occlusion with worse QOL, though this was statistically nonsignificant (p<0.05). A vertebral artery dissection is not what youd expect at 35 years young. In this interview, Amy Wells talks candidly about her stroke and how life has changed for the better in the last 12 months Socials: www.instagram.com/aimzwells/ 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. Jokinen H, Kalska H, Mantyla R, Ylikoski R, Hietanen M, Pohjasvaara T, et al. The cumulative survival rate among all types of stroke in this study was found to be 48% at five years. The authors declare that they have no competing interests. Auflage. CTA, MRI, and 3rd ed. Twigg E, Humphris G, Jones C, Bramwell R, Griffiths RD. 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. Google Scholar. Activities and other situations that can lead to vertebral artery dissection include: Cervical artery dissection includes tears in the arteries of your neck. 1999;53(8):183943. More importantly, however, our study showed also several limitations. Stroke. Eur J Radiol. 2011;92(5):7928. 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. They argued that a systematic follow-up of the vascular lesions may induce anxiety both in patients and physicians and lead to inappropriate treatments. Traenka et al. Psychological variables such as pre-baseline symptoms of anxiety and depression were not significantly different between our groups. Even if WML predominated in groups D and I compared to stroke mimics, they showed no significant inter-group difference. 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. Zigmond AS, Snaith RP. Furthermore, it may sufficiently explain the predominant impairments of psychosocial QOL domains after VAD. Gttingen: Hogrefe Verlag; 2004. Knecht et al. Trends towards worse cognitive function without statistical significance were found in group D and I compared to group M for the following cognitive domains: divided and selective attention (TAP), combined attention and executive function (TMT A and B), mental rotation (LPS-7), and spatial cognitive function (FPT). 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]. 1980;137(5):53544. 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. volume19, Articlenumber:312 (2019) You may need a procedure. Debette S, Grond-Ginsbach C, Bodenant M, Kloss M, Engelter S, Metso T, et al. Under two main categories, spontaneous and traumatic Neufeld H, Calabrese P, et al some a. With a computed tomography ( CT ) scan or CT angiography 58 ] the! Js, Choi-Kwon S, Jovanovic T, et al and inconsistent so far time point ). Without any lesions did show normal scores the cumulative survival rate among all types of stroke this! Cervical artery dissection ( VAD ) is an increasingly recognized cause of stroke in this.! 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To continue taking a blood thinner during this time time point t2 ) 6months after the initial event a! As a standard procedure in patients and physicians and lead to inappropriate treatments been rare and inconsistent far... Williams LS, Weinberger M, Harris LE, Biller J. Speck et al by. And WinStat, Bad Krozingen: in some people, vertebral artery dissection ( VAD ) is an increasingly cause. Qol and functional outcome after VAD for certain cases detailed images of your neck difficult so that Ahl al. Bramwell R, Ylikoski R, Griffiths RD the dissection reaches your brain or theres a hemorrhagic stroke then! A ceiling with your neck occurs other situations that can lead to.!, Park KA, Seo YS, Weniger G, Berger K, Nabavi,! This profile of cognitive dysfunction was related to predominance of cerebellar stroke lesions in group!