(2002) [5], mean age 50years, (2) posttraumatic stress symptoms as significant predictor for reduced SS-QOL Speck et al. Endovascular therapy versus intravenous thrombolysis in cervical artery dissection ischemic stroke - results from the SWISS registry. Cervical artery dissection: trauma and other potential mechanical trigger events. The German version of the Post-Traumatic Stress Syndrome 14-Questions Inventory (PTSS-14) [21] was used at follow-up to determine posttraumatic stress symptoms. 2008;28(6):171128. 2006;67(10):180912. J Clin Neurol. 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. Fourth, maladaptive coping strategies were significant predictors for and associated with posttraumatic stress disorder in patients with cervical artery dissection in the study of Speck et al. PubMed Adding one additional base point in all individuals our self-constructed cognitive composite score (CCS) showed a range from score 1=normal to 10=completely pathological. This method enables healthcare providers to quickly pinpoint the dissection and determine its severity and acuity. Despite obvious overrepresentation of elderly VAD patients and the need for confirmation of our results by larger studies, the main findings are in line with all three younger aged study cohorts that were previously examined for health related QOL after cervical artery dissection as discussed above: (1) Significant percentage of patients with bad QOL (SS-QOL scoring) despite good functional outcome (mRS sccoring) - Fischer et al. Differential features of carotid and vertebral artery dissections: the CADISP study. Otherwise, antithrombotic therapy was In multivariate regression analysis only MMSE remained a poor predictor for QOL, explaining 12.6% of its variance. 88.2% of patients with dissection (group D) experienced acute cerebral ischemia. 2002;13(3):1927. (2013) [16], (2) VAD with subarachnoid hemorrhage (SAH) because it is considered to show distinct disease-related features [17], (3) acute preexisting psychological disorder, (4) alcohol or other substance abuse, (5) strong psychopharmacological medication, i.e. Finding Support, the Right Doctor, and Some Validation The months following that fateful workout session were a A 42-year WebCervical artery dissection, including carotid and vertebral artery dissection, has an estimated incidence of 3.54.5 per 100 000. Article Previous 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. Summary A 22-year-old male with no previous history of cardiovascular disease presented after a high-speed rollover motor vehicle collision. 2016;87(5):52630. Testbatterie zur Aufmerksamkeitsprfung (TAP) Version 2.2. Other sites of ischemia were occipital lobe in 17.6% of group D and 34.2% of group I, furthermore thalamus in 5.3% of group I. New York: Oxford University Press; 2006. Engelter ST, Grond-Ginsbach C, Metso TM, Metso AJ, Kloss M, Debette S, et al. 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. [21] broadened its application when evaluating the validity of the German version, showing a sensitivity of 82% and specificity of 92%. Characteristics and outcomes of vertebrobasilar artery dissection with accompanied atherosclerosis. MRI of the brain was regularly performed as a standard procedure in patients with suspected stroke such as the participants in our study. (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. Any activities that could result in whiplash injury or extended periods of hyperextension of your neck. 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). Follow-up group comparison of variables of paired samples for changes over time was performed by using the Wilcoxon-test. WebScore: 4.2/5 (61 votes) . 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. Flow diagram of the study population, a too severely disabled; b concurrent cerebral disease (dual pathology); c deceased. 2017;88(14):131320. Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, et al. Speck et al. Toschke AM, Tilling K, Cox AM, Rudd AG, Heuschmann PU, Wolfe CD. Monitoring typically includes magnetic resonance angiography every three to six months. Activities and other situations that can lead to vertebral artery dissection include: Cervical artery dissection includes tears in the arteries of your neck. 2. Gottwald B, Mihajlovic Z, Wilde B, Mehdorn HM. What is the life expectance after successful repair of aortic Kissela et al. Strege, R.J., Kiefer, R. & Herrmann, M. Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study. Herzogenrath: Vera Fimm; 2009. (2009) [6], mean age 46years, Czechowsky et al. 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. Secondary exclusion due to defined criteria decreased the number of baseline patients of group D to 34 and group M to 25. J Am Geriatr Soc. Its signs and symptoms can be vague, and diagnosis can be elusive. 3rd ed. The cerebellar cognitive profile. Last reviewed by a Cleveland Clinic medical professional on 08/07/2022. Procedures for vertebral artery dissection include: Most people make a full recovery. If the dissection reaches your brain or theres a hemorrhagic stroke, then blood thinners may not be safe. (2014) [46], mean age 44.8years. J Neurol Neurosurg Psychiatry. In the trauma bay, he complained of chest pain and dyspnea. The vertebral artery provides 20% of blood flow to your brain (the carotid artery supplies the other 80%). J Neurol Neurosurg Psychiatry. (2004) [58] showed in their study that a significant number of cervical artery dissection can occur in the older age group and can be diagnosed if considered. 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/ Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA. 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]. We thank Dr. Werner Wosniok from the Institute of Statistics at the University of Bremen, Bremen, for his statistical advice. Twigg E, Humphris G, Jones C, Bramwell R, Griffiths RD. 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]. Kissela B, Lindsell CJ, Kleindorfer D, Alwell K, Moomaw CJ, Woo D, et al. This important discrepancy of QOL and functional outcome after VAD remained to be sufficiently explained. Koolhaas JM, Bartolomucci A, Buwalda B, de Boer SF, Flugge G, Korte SM, et al. Plasma homocysteine, MTHFR C677T, CBS 844ins68bp, and MTHFD1 G1958A polymorphisms in spontaneous cervical artery dissections. In a subsequent multiple regression analysis, neurocognition at baseline measured by MMSE, neurostatus at baseline measured by mRS and posttraumatic stress symptoms measured by PTSS-14 proved to be independent predictors for the quality of life at follow-up, explaining in combination 71% of its variance. 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. The vertebral arteries have many small branches. (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. 2018;265(8):18919. Your two carotid arteries run along either side of your neck in the front. 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. Both conditions fit if someone is suffering from a spontaneous artery dissection as well as subarachnoid hemorrhage in contrast to ischemic stroke caused by vascular risk factors which can be treated. 2011;92(5):7928. Their mixed series included about two third of patients with spontaneous internal carotid artery dissection (ICAD) and one third with VAD. 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. 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. Therefore, mRS scoring of 02 at follow-up was used as a good functional outcome. Radtke FM, Franck M, Drews T, Weiss-Gerlach E, Twigg E, Harbeck-Seu A, et al. 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. Tourette syndrome is a childhood onset neuropsychiatric disorder characterized by involuntary or urge-driven motor and vocal tics. 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. WebThe vertebral arteries are part of the circulatory system. 1997;19(1):612. 2006;66(4):5136. Achievable are 14 to 98 points from 14 items. Previous studies described poststroke cognitive decline by global cognitive screening such as MMSE and more recently and more sensitively by MoCA [42]. Vertebral artery dissection (VAD) is increasingly identified as a cause of ischemic stroke in young adults. Kiphuth IC, Utz KS, Noble AJ, Kohrmann M, Schenk T. Increased prevalence of posttraumatic stress disorder in patients after transient ischemic attack. 2014;76(9):6707. Neurology. Anasthesiol Intensivmed Notfallmed Schmerzther. Brain. Ischemic stroke was found in only 33.9%. 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. Spontaneous dissection of the carotid and vertebral arteries. 8. 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). J Neurol. 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]. Med Hypotheses. 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. 2005;76(9):122933. 88.2% of patients with VAD suffered from acute cerebral ischemia. Toglia J, Fitzgerald KA, O'Dell MW, Mastrogiovanni AR, Lin CD. MoCA, to our best knowledge, was used in our study for the first time in VAD patients. Thus, somewhat unspecific symptoms in this age group and context of VAD history, if not critically reflected, may usually prompt otherwise evitable inpatient diagnostics for stroke and/or recurrence of dissection. Schievink WI. This risk decreases over time. 1997;9:44551. (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. "mini-mental state". 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. Chronic posttraumatic stress symptoms after nonsevere stroke. 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]. Your healthcare provider may recommend alternative treatments. 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