First of all, the study cohort showed an unusual high percentage of elderly VAD patients (mean age 62.611.9). 1989;20(7):86470. AJR Am J Roentgenol. Cervical artery dissection, including VAD and carotid artery dissection, are rare complications of pregnancy. Strege, R.J., Kiefer, R. & Herrmann, M. Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study. In multivariate regression analysis only MMSE remained a poor predictor for QOL, explaining 12.6% of its variance. 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). Tucson: Neuropsychological Press; 1985. 2006;22(23):215. 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). Grond-Ginsbach C, Metso TM, Metso AJ, Pezzini A, Tatlisumak T, Hakimi M, et al. These include vertebral and carotid arteries. 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. Cerebrovasc Dis. Flow diagram of the study population, a too severely disabled; b concurrent cerebral disease (dual pathology); c deceased. Disabil Rehabil. (2009) [6]. These findings corresponded widely to findings of Gottwald et al. They found 81% with good functional outcome (mRS02) but only 66.6% with good SS-QOL scoring. Preceding correlation analyses in this study yielded significant correlations in between all neurocognitive measures such as MMSE, MoCA, and CCS at baseline and likewise in between both neurostatus measures such as NIH-SS on admission and mRS at baseline. For both future research and clinical treatment, our data favor a multidimensional monitoring after VAD, with special focus on neuropsychiatric sequelae. Third, psychological condition was not examined at baseline. Lower scores of both global screening systems, MMSE and MoCA, were independent negative predictors for QOL at follow-up in univariate regression analysis. Acta Psychiatr Scand. While there were in groups D and I compared to group M frequent impairments in both global screening tests (MMSE, MoCA) and in single cognitive function tests of the neuropsychological test battery (Additionalfile1) and also in the resulting cognitive composite score (CCS), this difference reached statistical significance only in the MoCA assessment for group D compared to group M (Table2). Neurology. A total score of 40 points may be indicative for posttraumatic stress disorder. Engel GL. Chicago: University of Chicago Press; 1947. Speck et al. 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. 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. Medical therapy and ongoing monitoring can help people with vertebral artery dissection avoid complications. 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. The statistical data analyses were conducted using SPSS Statistics Version 22 and WinStat, Bad Krozingen. Procedures for vertebral artery dissection include: Most people make a full recovery. Google Scholar. (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. Elevated levels of posttraumatic stress symptoms, as evaluated by PTSS-14 scoring in our study, are in line with recent reports on the prevalence of posttraumatic stress disorder (PTSD) after stroke, even after minor stroke [49] or transient ischemic attack [50]. WebFibromuscular dysplasia (FMD) affects the artery walls, making them either too weak or too stiff. The overrepresentation of elderly patients in our study may be most probably explained to some extent by a hospital-based selection bias: (1) Patients were recruited when referred to the supraregional stroke unit of our teaching hospital. MH contributed to the experimental design, data analyses and manuscript writing. At follow-up assessment, group M showed the best distribution of mRS scores in direction to better ones and group D the worst with a significant higher mean score of mRS. Group-related changing in mRS scoring between time points t1 (baseline) and t2 (6months follow-up), group D patients with dissection; group I patients with ischemia without dissection; group M stroke mimics; mRS modified Rankin Scale; n. s. not significant, * significant difference. 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. Herrmann M, Freyholdt U, Fuchs G, Wallesch CW. Patient-specific recovery patterns over time measured by dependence in activities of daily living after stroke and post-stroke care: the South London Stroke Register (SLSR). Spearmans rank correlation analysis yielded a highly significant correlation (p<0.001) between all three cognitive scoring systems (MMSE, MoCA, and CCS). This can lead to serious complications, including arterial narrowing (stenosis), weakening/bulging (aneurysm) or tearing (dissection). No further differences were found in the other domains. In an exploratory study, 34 consecutive patients with first-ever spontaneous VAD were prospectively examined in comparison to 38 patients with cerebral ischemia without dissection and 25 stroke mimics as control groups. The study protocol was approved by the Local Ethics Committee of the University of Bremen. Patients most commonly present with neck pain, headache, visual disturbance, or focal extremity weakness. Psychological variables such as pre-baseline symptoms of anxiety and depression were not significantly different between our groups. They included benign paroxysmal positional vertigo in 40%, vestibular neuritis in 24%, vestibulocochlear irritation in 4%, Schwannoma in 4%, suspected somatoform dizziness in 8% and nonspecific dizziness of unknown origin in 16%. Czechowsky D, Hill MD. Current recommendations for patients with FMD are to avoid resistance training during the first 8-12 weeks after acute carotid or vertebral artery dissections. According to modern stress concepts, situations that in particular include unpredictability and uncontrollability can trigger stress [54]. This option is also for people with hemorrhagic stroke. Knecht et al. The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. Published data about the possible impact of stenosis or occlusion of dissected vertebral artery to outcome have been rare and inconsistent so far. 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. 88.2% of patients with dissection (group D) experienced acute cerebral ischemia. Secondary exclusion due to defined criteria decreased the number of baseline patients of group D to 34 and group M to 25. Most dissections heal on their own. The health-related quality of life regarding the week before baseline and at follow-up was assessed by the German version [22] of the Stroke Specific Quality Of Life Scale (SS-QOL) [7]. Vertebral artery dissection: presenting findings and predictors of outcome. In addition, differentiation of dissection from rupture of atheroma in the context of arteriosclerosis may be difficult so that Ahl et al. Later on, I began to have disturbances in my vision, ie. Apart from the presence of ischemic stroke lesions in groups D and I, socio-demographic and clinical data of the three groups were without significant differences, as shown in Table1. Background: Vertebral artery dissection (VAD) may cause cerebral ischemia and impair quality of life (QOL) despite of good functional outcome. Sometimes, your healthcare provider may recommend conventional angiography. Source Reference: Markus H, et al "Antiplatelet therapy vs anticoagulation therapy in cervical artery dissection: the Cervical Artery Dissection in Stroke Study Their mixed series included about two third of patients with spontaneous internal carotid artery dissection (ICAD) and one third with VAD. 1 It is an important cause of stroke in the young, particularly in otherwise healthy patients without traditional vascular risk factors. 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). Cervical artery dissection is commonly considered to be underdiagnosed [3, 57,58,59]. Dissection in either artery can disrupt blood flow and potentially cause a stroke. 2014;45(11):33606. 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. Article Classification of subtype of acute ischemic stroke. Although specific information about overall life expectancy after aortic dissection repair is not available, a recent study from the International Registry of Acute Aortic Dissection reported that about 85% of patients who have undergone successful repair of acute dissection involving the ascending aorta remain alive at 5 years. This profile of cognitive dysfunction was related to predominance of cerebellar stroke lesions in both group D and group I. A dissection is a tear in one or more tissue layers that make up your vertebral artery. National Institute of Health Stroke Scale, Posttrauamtic stress syndrome 14-questions inventory. volume19, Articlenumber:312 (2019) A summary score of 4.0 was considered to indicate good QOL, a score3.9 bad QOL in accordance with Fisher et al. Halstead WC. Healthcare providers can often diagnose a vertebral artery dissection with a computed tomography (CT) scan or CT angiography. Gttingen: Hogrefe Verlag; 2004. Comparison of cognitive baseline profiles of the three groups revealed no significant differences. Cervical artery dissection: trauma and other potential mechanical trigger events. 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%). Turm von London Deutsche Version. Cervical artery dissections typically heal very well, returning the vessel to normal. This process usually occurs within the first three to six months. Whats it like living with a cervical artery dissection? Youll need regular monitoring, including imaging studies, until healthcare providers confirm the dissection has healed. Rodallec MH, Marteau V, Gerber S, Desmottes L, Zins M. Craniocervical arterial dissection: spectrum of imaging findings and differential diagnosis. 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. You may face a higher risk of dissection if you have certain health conditions, including: Injury can also cause dissection. Mean values of mRS scoring improved from baseline to follow-up in all three groups but significantly only in group I. Plank position (but otherwise safe to participate in yoga or Pilates). 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]. Kim JS, Choi-Kwon S, Kwon SU, Lee HJ, Park KA, Seo YS. 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. Even if WML predominated in groups D and I compared to stroke mimics, they showed no significant inter-group difference. Your healthcare provider may recommend alternative treatments. 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. A total of 327 patients were enrolled from 2012-2106. WebThe vertebral arteries are part of the circulatory system. Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study, https://doi.org/10.1186/s12883-019-1541-x, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. Neurology. To diagnose VAD may be difficult because of the wide range of symptoms, from isolated local signs to posterior circulation stroke. The second data collection was achieved by written standardized, structured questionnaire at follow-up (time point t2) 6months after the initial event. (2) Broad neuroimaging of cervical arteries including cervical MRA was regularly applied to patients of all age groups and risk profiles whenever differential diagnosis of VAD appeared to be possible. 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. Trigger events, a too severely disabled ; b concurrent cerebral disease ( dual pathology ) ; deceased! Cognitive dysfunction was related to predominance of cerebellar stroke lesions in both group D and group M 25... Underdiagnosed [ 3, 57,58,59 ] higher risk of stroke in the other domains focal. 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