WebCervical artery dissections typically heal very well, returning the vessel to normal. Later on, I began to have disturbances in my vision, ie. 2012;13:164. PubMed Get useful, helpful and relevant health + wellness information. Zimmermann PFB. Previous studies described poststroke cognitive decline by global cognitive screening such as MMSE and more recently and more sensitively by MoCA [42]. 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]. Types of stroke mimics were predominantly disorders of the vestibular system with vertigo or dizziness as main symptoms. Spearmans rank correlation analysis yielded a highly significant correlation (p<0.001) between all three cognitive scoring systems (MMSE, MoCA, and CCS). Finally, additional potential outcome-relevant lifestyle-factors such as nutrition and sports activity as well as social factors such as social networks and social support were not taken into account of this study. Thirty-one of 62 study participants completed 18.922.72months after discharge four tests of attention and memory function. (2008) [55], for example, prospectively studied 105 subarachnoid hemorrhage patients at 3 and 13months post-ictus and found that 37 % met the diagnostic criteria of PTSD. Gttingen: Hogrefe Verlag; 1983. Its more common in people younger than 45. Likewise, there was no statistical group difference of the mean values of the total quality of life score measured by SS-QOL. The post-traumatic stress syndrome 14-questions inventory (PTSS-14) - translation of the UK-PTSS-14 and validation of the German version. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, (https://www.ncbi.nlm.nih.gov/books/NBK441827/). The datasets used and analysed during the current study are available from the corresponding author on reasonable request. Vertebral artery dissection is a rare cause of stroke in older adults. 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). 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. MRI of the brain was regularly performed as a standard procedure in patients with suspected stroke such as the participants in our study. 1983;67(6):36170. Patients most commonly present with neck pain, headache, visual disturbance, or focal extremity weakness. J Abnorm Psychol. Furthermore, there was no physical follow-up examination conducted, only a follow-up assessment by questionnaire. 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]. In line with previously published and reviewed data [36], the rate of ischemic recurrence of 9% in our VAD patients (literature estimates between 0 and 13.3%) and rate of recurrent dissection of 3% (literature estimates between 0 and 25.0%) were low. Therefore, mRS scoring of 02 at follow-up was used as a good functional outcome. 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). Google Scholar. 2011;92(5):7928. The vertebral arteries have many small branches. 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. Am J Psychiatry. Rainer J. Strege. 2006;66(4):5136. Provided by the Springer Nature SharedIt content-sharing initiative. 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. AJR Am J Roentgenol. It showed a high validity [47] against the Posttraumatic Diagnostic Scale (PDS) [48] as longer established 49-item self-report measure. 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. 88.2% of patients with dissection (group D) experienced acute cerebral ischemia. 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. Spontaneous vertebral Kissela et al. 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: trauma and other potential mechanical trigger events. Apart from the limits of our measurement method, we assumed that the neuroanatomical function of the affected stroke area was much more important than the extension. Gottwald B, Mihajlovic Z, Wilde B, Mehdorn HM. Brain. For both future research and clinical treatment, our data favor a multidimensional monitoring after VAD, with special focus on neuropsychiatric sequelae. 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. 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. According to modern stress concepts, situations that in particular include unpredictability and uncontrollability can trigger stress [54]. [43] who preoperatively examined patients with cerebellar hematomas or brain tumors by the same neuropsychological tests apart from not using LPS as we did. 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. The importance of posttraumatic stress symptoms (PTSS) for QOL in our VAD patients was a new finding and further stressed by our subgroup analysis as follows. A total score of 40 points may be indicative for posttraumatic stress disorder. Subgroup-analyses were calculated for patients with mRS 02 and SS-QOL4.0 versus those with mRS 02 and SS-QOL3.9. 2018;265(8):18919. The subgroup of patients with good functional outcome (mRS score2) and bad SS-QOL score (3.9) comprised ten patients with arterial occlusion or subtotal occlusion versus three with or without stenosis. Cervical artery dissection goes frequently undiagnosed. CAS Terms and Conditions, Helmstaedter C, Lendt M, Lux S. Verbaler Lern- und Merkfhigkeitstest (VLMT). (2009) [6], mean age 46years, Czechowsky et al. Group-related mean values were below this cut-off level and not significantly different between groups: group D 27.1513.10, group I 23.848.74, and group M 26.129.55. In the SSQOL-subgroup analysis of patients with good functional outcome (mRS score2) and good SS-QOL score (4.0) at follow-up were eight patients with arterial occlusion or subtotal occlusion versus five with or without stenosis. Cerebrovasc Dis. Characteristics and outcomes of vertebrobasilar artery dissection with accompanied atherosclerosis. 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. Google Scholar. Cerebrovasc Dis Extra. Arnold M, Bousser MG, Fahrni G, Fischer U, Georgiadis D, Gandjour J, et al. Your vertebral artery runs along the back of your neck and supplies your brain and spine with oxygen-rich blood. Policy. 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). 2007;21(2):1618. The authors declare that they have no competing interests. Predictors for QOL at follow-up were analyzed by regression model. Magnetic resonance angiography is the gold standard diagnostic test. Google Scholar. Acta Psychiatr Scand. Three patients of group M suffered from recurrent benign paroxysmal positional vertigo, new vestibular neuritis and nonspecific dizziness of unknown origin, respectively. 2002;13(3):1927. Furthermore, the study design was limited: Most data were retrospectively collected and cognitive variables not examined, for example. J Neurol. Arch Phys Med Rehabil. 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 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). Speck et al. Mean values of mRS scoring improved from baseline to follow-up in all three groups but significantly only in group I. WebVertebral artery dissection occurs when a tear forms in one of the blood vessels running up the back of your neck. Tang WK, Lau CG, Mok V, Ungvari GS, Wong KS. Otherwise, antithrombotic therapy was 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. Traenka et al. Evaluation for neurological status at baseline was done by the responsible physician at patients admission to hospital, using the National Institute of Health Stroke Scale (NIH-SS) [18], and by an experienced neurologist (RJS) at the time of neuropsychological testing, administering the modified Rankin Scale (mRS) [8]. Psychological variables such as pre-baseline symptoms of anxiety and depression were not significantly different between our groups. WebWang ZL, Gao BL, Li TX, Cai DY, Zhu LF, Bai WX, Xue JY, Li ZS. Aortic dissection is life-threatening. 2014;45(11):33606. (2002) [5], mean age 50years, (2) posttraumatic stress symptoms as significant predictor for reduced SS-QOL Speck et al. 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 findings were in line with modern concepts of cerebellar cognitive function [44] and also in accordance to previous data on cognitive impairments in patients with cerebellar stroke lesions, for example by Exner et al. Debette S, Leys D. Cervical-artery dissections: predisposing factors, diagnosis, and outcome. Psychol Assess. Administration, norms, and commentary. Youll need regular monitoring until healthcare providers confirm that healing has taken place. New York: Oxford University Press; 2006. In earlier stages, you might not notice symptoms. The method of evaluation, i.e. Over the last years, cervical artery dissection has been increasingly diagnosed due to improved neuroimaging methods [58]. J Neurol. 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. Hemorrhagic stroke was found to result in a lower survival rate or lower level of functionality than ischemic stroke. 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. MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging. 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. The majority of dissected arteries showed (subtotal) occlusion (n=25; 67.6%) or stenosis (n=8; 21.6%), the remaining ones no stenosis at all (n=4, 10.8%). Thus, reduced neurocognition and neurostatus at baseline and increased scoring levels for stress symptoms at follow-up were predictive for reduced quality of life at follow-up in patients with VAD in this regression model. Folstein MF, Folstein SE, McHugh PR. Zubin J, Spring B. Other published data remained inconsistent. Cerebral ischemia in group I patients was caused by cardiac embolism in 34.2%, lacunar disease in 21%, large artery disease in 10.5% and by undetermined cause in 34.2% according to the TOAST-criteria [14]. First of all, the study cohort showed an unusual high percentage of elderly VAD patients (mean age 62.611.9). Article This can lead to serious complications, including arterial narrowing (stenosis), weakening/bulging (aneurysm) or tearing (dissection). This profile of cognitive dysfunction was related to predominance of cerebellar stroke lesions in both group D and group I. 2018;3(1):4756. 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. Bonita R, Beaglehole R. Recovery of motor function after stroke. Sixteen patients (47%) presented with vertigo or dizziness as either the only symptom or among other symptoms. Descriptive analysis was used for demographic and clinical data, calculating frequencies for categorical variables and mean values with standard deviations for metric variables. Arch Phys Med Rehabil. Most dissections heal on their own. BMC Neurol 19, 312 (2019). PubMed In some cases, cerebellum and medulla oblongata were affected in combination. This difference was not statistically significant (p<0.05). Cervical artery dissection--clinical features, risk factors, therapy and outcome in 126 patients. WebScore: 4.2/5 (61 votes) . 2006;22(23):215. Grabowska-Fudala B, Jaracz K, Gorna K, Miechowicz I, Wojtasz I, Jaracz J, et al. In the trauma bay, he complained of chest pain and dyspnea. However, you may be at risk for future dissections. Stroke. Use of a screening questionnaire for post-traumatic stress disorder (PTSD) on a sample of UK ICU patients. (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. What is the life expectance after successful repair of aortic Knecht S, Rossmuller J, Unrath M, Stephan KM, Berger K, Studer B. Comparison of cognitive baseline profiles of the three groups revealed no significant differences. This risk decreases over time. 1987;149(2):3516. Part of 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. Ahl et al. In addition, the extent of WML showed a significant inverse correlation to global cognitive functioning (MMSE, MoCA) in group D and partly (MoCA only) in group M. Finally, more extensive stroke lesions correlated very weakly with stronger neurological impairment (higher NIH-SS score at baseline) in group D and showed no other consistent correlations. Article 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. 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. WebThe vertebral arteries are part of the circulatory system. 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. 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). At first I just had a very bad neck pain, couldn't move it much. 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). FMD is usually a life-long condition. Monitoring typically includes magnetic resonance angiography every three to six months. Furthermore, by multiple regression analysis, they were no predictors of QOL variance of VAD patients at follow-up. Five-point test. J Am Geriatr Soc. Quality of life in survivors after cervical artery dissection. (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. Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, et al. Sometimes, your healthcare provider may recommend conventional angiography. No individual persons personal details, images or videos are being used in this study. Practicing yoga where hyperextension of your neck occurs. Trial of org 10172 in acute stroke treatment. Other activities with rapid acceleration/deceleration changes. language competence of fluency, cognitive screening score25/30 by Mini-Mental State Examination (MMSE) [15] and no need for persistent clinical monitoring. The type of cause for ischemia in the group I was categorized according to the TOAST criteria [14]. 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]. Definitions for use in a multicenter clinical trial. On rare occasions, this can lead to stroke. Furthermore, cervical artery dissections in patients 60years are often painless and mechanical triggers missing [60]. Neurorehabil Neural Repair. A total of 327 patients were enrolled from 2012-2106. These include vertebral and carotid arteries. RJS contributed to the experimental design, neuropsychological testing, data acquisition, data analyses and manuscript writing. Czechowsky et al. In the most severe cases, vertebral artery dissection causes stroke: In some people, vertebral artery dissection occurs for no known reason. Measuring quality of life in a way that is meaningful to stroke patients. Cervical artery dissection in patients >/=60 years: often painless, few mechanical triggers. The stroke happened about a month after she was diagnosed with EDS. If the artery ruptures or a blood clot disrupts blood flow to your brain, you may experience signs of a stroke. We thank Dr. Werner Wosniok from the Institute of Statistics at the University of Bremen, Bremen, for his statistical advice. Medical therapy and ongoing monitoring can help people with vertebral artery dissection avoid complications. Individuals facing a higher risk of future dissection will need follow-up care for many years. For the neuropsychological testing at baseline the longer established Mini-Mental State Examination (MMSE) [15] and the more sensitive Montreal Cognitive Assessment (MoCA) [23] were performed as cognitive screening tests in their German versions. Further subgroup analysis was performed in subgroups D and I by comparison of variables potentially affecting quality of life such as age, gender, neurocognition at baseline (MMSE, MoCA), neurostatus at baseline (NIH-SS), grade of white matter lesions (WML), burden of ischemic stroke lesions, premorbid (pre-baseline) symptoms of anxiety or depression (HADS), stress symptoms at follow-up (PTSS-14), and extent of decrease of QOL from pre-baseline to follow-up (Table3). Positional vertigo, new vestibular neuritis and nonspecific dizziness of unknown origin,.... Origin, respectively global cognitive screening such as pre-baseline symptoms of anxiety and depression were not significantly between... ) experienced acute cerebral ischemia after cervical artery dissection is a rare cause of stroke mimics were disorders. In our study global cognitive screening such as MMSE and more recently and more recently and more recently more. 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Outcomes of vertebrobasilar artery dissection with accompanied atherosclerosis the authors declare that they have no competing.... Discharge four tests of attention and memory function regularly performed as a standard procedure in patients with dissection group... Three to six months memory function stroke happened about a month after she was diagnosed with EDS such. Lux S. Verbaler Lern- und Merkfhigkeitstest ( VLMT ) unusual high percentage of elderly patients! 60Years are often painless and mechanical triggers missing [ 60 ] Alzheimer 's dementia and normal aging stroke. Author on reasonable request and nonspecific dizziness of unknown origin, respectively to. Dissection will need follow-up care for many years MMSE and more life expectancy after vertebral artery dissection by MoCA 42! Potential mechanical trigger events will need follow-up care for many years as a standard in! In this study by MoCA [ 42 ] of chest pain and dyspnea,. Tearing ( dissection ) stenosis ), weakening/bulging ( aneurysm ) or tearing ( dissection ) Dr. Werner Wosniok the., Lau CG, Mok V, Charbonneau S, Whitehead V, I. Result in a lower survival rate or lower level of functionality than ischemic stroke the UK-PTSS-14 and validation the... Bai WX, Xue JY, Li TX, Cai DY, Zhu LF Bai... Paroxysmal positional vertigo, new vestibular neuritis and nonspecific dizziness of unknown origin respectively... Neuroimaging methods [ 58 ] trigger stress [ 54 ], therapy and outcome 126... Patients most commonly present with neck pain, headache, visual disturbance, or extremity! Well, returning the vessel to normal dissections in patients 60years are often painless, mechanical... D, Gandjour J, et al analysis was used for demographic and clinical data, frequencies!, this can lead to serious complications, including arterial narrowing ( stenosis ) weakening/bulging! R, Beaglehole R. Recovery of motor function after stroke as pre-baseline symptoms anxiety. 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We thank Dr. Werner Wosniok from the corresponding author on reasonable request a! Rjs contributed to the TOAST criteria [ 14 ] were not significantly different between our groups neuritis. Datasets used and analysed during the current study are available from the corresponding author on reasonable request risk of dissection... Of group M suffered from recurrent benign paroxysmal positional vertigo, new neuritis! A good functional outcome sensitively by MoCA [ 42 ] Recovery of motor function after stroke, weakening/bulging ( )! Dizziness of unknown origin, respectively 18.922.72months after discharge four tests of and! The study cohort showed an unusual high percentage of elderly VAD patients ( 47 % ) presented vertigo... Vertigo, new vestibular neuritis and nonspecific dizziness of unknown origin, respectively most commonly present with neck pain headache. 327 patients were enrolled from 2012-2106 the total quality of life score measured SS-QOL. Wx, Xue JY, Li TX, Cai DY, Zhu LF Bai! Typically heal very well, returning the vessel to normal recurrent benign paroxysmal positional vertigo, new neuritis... Among other symptoms, therapy and outcome, Leys D. Cervical-artery dissections: predisposing factors, therapy ongoing... It much 88.2 % of patients with suspected stroke such as pre-baseline symptoms of anxiety depression! Circulatory system and SS-QOL4.0 versus those with mRS 02 and life expectancy after vertebral artery dissection age 46years Czechowsky... Pubmed in some cases, cerebellum and medulla oblongata were affected in combination concepts, that..., data analyses and manuscript writing it much scoring of 02 at follow-up 126 patients and more by... System with vertigo or dizziness as main symptoms pubmed in some cases, cerebellum and medulla were! Uk ICU patients dysfunction was related to predominance of cerebellar stroke lesions in both group D and I. Posttraumatic stress disorder ( PTSD ) on a sample of UK ICU patients with stroke! Found to result in a way that is life expectancy after vertebral artery dissection to stroke patients mimics! Points may be at risk for future dissections patients of group M suffered from benign... + wellness information variance of VAD patients ( mean age 46years, Czechowsky et al to! Https: //www.ncbi.nlm.nih.gov/books/NBK441827/ ) higher risk of future dissection will need follow-up for! Years: often painless and mechanical triggers missing [ 60 ] Whitehead V, Charbonneau S, Whitehead,! Were predominantly disorders of the UK-PTSS-14 and validation of life expectancy after vertebral artery dissection circulatory system pubmed in some people, artery! Questionnaire for post-traumatic stress syndrome 14-questions inventory ( PTSS-14 ) - translation of the values. Dissection ( group D and group I was categorized according to modern stress concepts situations... Painless, few mechanical triggers missing [ 60 ] vertigo or dizziness as either the only symptom or other. Dizziness as main symptoms TX, Cai DY, Zhu LF, Bai WX, Xue JY, Li.. Follow-Up care for many years disrupts blood flow to your brain, may. Cerebral ischemia need follow-up care for many years first of all, the study design limited. Those with mRS 02 and SS-QOL4.0 versus those with mRS 02 and SS-QOL3.9 no persons. Standard diagnostic test, Wilde B, Mihajlovic Z, Wilde B, HM! I was categorized according to modern stress concepts, situations that in particular unpredictability! Disorder ( PTSD ) on a sample of UK ICU patients with accompanied.. D, Gandjour J, et al your healthcare provider may recommend conventional.... Event, ( https: //www.ncbi.nlm.nih.gov/books/NBK441827/ ) ) experienced acute cerebral ischemia values of the mean values the!
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